What to Do When Receiving Radiation Therapy to the Pelvis

What to Do When Receiving Radiation Therapy to the Pelvis UHN For patients with gynecological cancer Learn the main steps in planning radiation treatment and how to manage side effects during radiation treatment. Table of Contents Patient Education Improving health through education What You Need to Know About Your CT Planning Appointment... 2 What You Need to Know About Your Radiation Treatment Appointments... 3 Side Effects You May Experience... 5 What to Expect After Radiation Treatment... 8 Things That May Happen After Radiation Therapy... 9 Learn More with These Resource... 9 Introduction Many patients find pelvic radiation treatment to be quite easy. Many have only minor side effects. Some patients may have more side effects. How you will react to radiation treatment is impossible to predict before it happens. You may be able to prevent or reduce some of the side effects during radiation treatment if you use the information. in this booklet. Your radiation oncologist, oncology nurse and radiation therapists will provide you and your family with care, support, and information throughout your treatment. Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca 2012 University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only. Author: Angela Cashell, Radiation Medicine Program Created: 11/2004 (02/2012) Form: D-5050 C034-D

This booklet provides you with general information. If you have more questions: Ask your radiation therapist when you go in for treatment. If they can t answer your question they will find someone who can. Ask your oncologist or oncology nurse at your weekly review appointment. If you have any questions about your appointments please call (416) 946-4501 ext 6483 Let us know as soon as possible if you prefer to speak in a language other than English. The hospital can arrange for an interpretation service for you. What You Need to Know About Your CT Planning Appointment Where do I go for this appointment? Your CT planning appointment will be at Princess Margaret Hospital. Check in at the Reception Desk on level 1B (1 below the main floor) when you arrive. Your picture will be taken to help us identify you while you are receiving radiation treatment. How long is this appointment? You should plan to be at the hospital for 1 to 2 hours, although the time needed to complete the procedure is usually much less. Do I need to prepare before coming to this appointment? You may need to empty your rectum before the visit. You may also need to have your bladder comfortably full. Your oncology nurse will let you know if you need to do this before your CT planning appointment. He or she will give you an instruction sheet, Getting Ready for your CT Planning Scan and Treatments that will teach you how to do this. If you have not been asked to do anything to prepare, you should continue to eat and drink normally. You should also continue to take all medicines that have been prescribed by your radiation oncologist or other doctors. 2

Do not use vaginal tampons during your CT planning appointment or during your radiation treatments. What will happen at the appointment? A. The goal of this visit is to have a CT or MRI scan of your pelvis to plan your treatment. These pictures will provide your radiation oncologist and other members of the treatment team with the information they need to plan your radiation treatment. The CT or MRI scan pictures will show the radiation oncologist and other members of the treatment team what areas need to be treated with radiation. They will also be able to see what normal organs they will need to protect during your treatment. B. Marks will be placed on your skin after the scans have been completed. This is done so that the radiation treatment can be given to you in the same way each day. These marks need to stay on your skin throughout treatment. To make sure your marks stay visible, small permanent tattoos, the size of a freckle, are used to mark the spot so that they cannot be rubbed or washed off. The tattoos will be done by your radiation therapists, using a small sterile needle. Your radiation therapists will explain the procedure to you ahead of time. After your planning visit is complete, your treatment team will continue to work behind the scenes to prepare a treatment plan that is tailored for you. What You Need to Know About Your Radiation Treatment Appointments Where do I go for my radiation treatment appointments? Your radiation treatment will be at Princess Margaret Hospital. Check in at the Reception Desk on level 2B (2 below the main floor) when you arrive. Can I schedule my radiation treatment appointments at times that are convenient for me? Unfortunately, because of the large number of patients that need to be treated every day we can t guarantee specific appointment times. However, your radiation therapists will try to help you out if there are special circumstances. 3

How long will radiation treatment take each day? You should plan to be at the hospital for 1 hour each day, although the time needed for your treatment is usually 15 to 20 minutes. Your first treatment may take longer because your radiation therapists will be checking all the information before giving you your treatment. On the first day, they may also take some more x-ray pictures just before your treatment starts to confirm that it matches what your radiation oncologist planned. Each day, including the first day, a Cone Beam CT scan ( mini CT ) will be taken of the treatment area. This is done to check that you are in the correct position before you are treated. The pictures do not give any information about how your tumor is responding to treatment. How many radiation treatments will I receive each day? Most patients receive one (1) radiation treatment each day. However, due to statutory holidays or machine availability, some women may need two (2) treatments on some days. Your treatment team will tell you if this is necessary for you. Do I need to prepare before coming for the radiation treatment appointment? You need to prepare for your radiation treatment appointments the same way that you prepared for your CT planning appointment. This means that if you were asked to have an empty rectum and comfortably full bladder for your planning appointment, you will have to do the same thing for all your radiation treatment appointments. You will receive an instruction sheet to teach you how to do this. It is called, Getting Ready for your CT Planning Scan and Radiation Treatments prior to your CT planning scan if you need to prepare your rectum and bladder. If you have not been asked to do anything to prepare you should continue to eat normally. If you are taking medicines, continue to take all medicines that have been prescribed by your radiation oncologist or other doctors. Do not use vaginal tampons during your CT planning appointment or during your radiation treatments. 4

Who should I talk to if I have questions or develop side effects? Your radiation therapists will try to answer your questions every day when you come for treatment. If they cannot answer your question, they may refer you to other members of your health care team. During your treatment, you will be scheduled to see your radiation oncologist or another doctor that works with your radiation oncologist once each week. This appointment is to make sure that your radiation treatment is going as planned. They will also make sure that any side effects you may be feeling are treated. You will have the chance to ask the doctor and oncology nurse questions at this appointment. Side Effects You May Experience Side effects from radiation are different for everyone. The type of side effect and how much it will affect you depends on: The parts of the body being treated The type of radiation used The amount of radiation given The person s general health Other factors that cannot be predicted A. Tiredness Some patients may feel more tired than others. Tiredness often begins 2 to 3 weeks after you start radiation treatment. This may be made worse by poor sleep, emotional stress, and daily travel to the hospital for treatment. What you can do: Stay physically active but pace your activities Don t expect too much of yourself Continue activities that you enjoy such as short walks, music, reading and other hobbies Ask family or friends to help you with household chores and other commitments Eat snacks often throughout the day. Keep ready-to-eat foods with you all the time. Drink plenty of fluids Get enough sleep 5

B. Loss of Appetite You may lose interest in food while receiving radiation treatment, but it is important that you try to keep eating normally during your treatment. What you can do: Do some light exercise Get some fresh air Eat small meals often Eat foods that you enjoy Make your food interesting and appealing Drink plenty of fluids A dietitian can give you advice about what foods to eat. He or she will also be able to tell you what nutrients your body needs. Your radiation therapists or oncology nurse can schedule an appointment for you and your family with a dietitian. C. Bowel cramping (stomach ache) and diarrhea You may feel cramping in your bowel (stomach ache) or diarrhea. These feelings can begin as early as the 1st week of treatment. The feelings are usually mild and can be treated. What you can do: Continue with what you would normally eat until you feel cramping or diarrhea Eat food that are low in fiber Eat foods that are low in fat Avoid milk products (lactose) Avoid caffeine and/or spices Eat 5 or 6 smaller meals instead of 3 larger meals each day Drink 8-10 cups of liquids each day to prevent dehydration if you have diarrhea Medicines, such as Imodium, may be needed to help control cramping or diarrhea. For more information, ask your radiation therapists or oncology nurse for the Eating Hints for People with Diarrhea information booklet. You can also ask your radiation therapists or oncology nurse to book an appointment for you and your family to see a dietitian. A dietitian can give you advice about your diet and nutritional needs. 6

D. Frequent urination and painful urination You may feel the need to urinate often or feel pain when you urinate. You may also feel cramps in your bladder. You may be feeling these symptoms because of the radiation therapy or a bladder infection. What you can do: Drink plenty of fluid during the day. Do not drink as much water or fluid starting an hour or two before you go to bed. This will help reduce how often you need to urinate during the night. Avoid drinks with caffeine such as coffee, tea, and cola. Speak to your radiation oncologist, oncology nurse or radiation therapist if these symptoms continue. They may check to see if you have a bladder infection. There may be some medicine you can take to help you feel better. E. Changes in your blood Radiation treatment to the pelvis usually does not cause big changes in your blood. However, if you are also receiving chemotherapy, there may be some changes in your blood such as lower amounts of: red blood cells white blood cells platelets Your healthcare team may ask you to have regular blood tests if you are receiving chemotherapy. They may also ask you to have a blood test for other reasons. F. Warm, Dry, Itchy and Red Skin During radiation treatment, your skin may turn red in the treatment area, for example: the groin the area between the thighs the area around the anus These areas may feel warm, dry and itchy. If you have hemorrhoids, they may get worse during radiation treatment. 7

What you can do: Keep the area clean and continue to bathe or shower. Use a mild soap. Pat the skin dry with a soft towel. Do not rub the skin. Keep the area dry. Expose the area to air whenever you can. Wear loose cotton underwear, (such as boxer shorts). Do not wear tight-fitting clothing such as nylon panty hose. Do not use feminine hygiene sprays. Take a Sitz bath. Sitz baths may help the skin around the groin area feel better. It may also prevent hemorrhoids from getting worse Ask your radiation therapists or oncology nurse for the Sitz Bath information booklet. You can keep taking Sitz baths for a few weeks after your treatment is finished. It may help with your skin side effects. Speak to your radiation oncologist or oncology nurse if these side effects do not go away. There may be some medicine you can take to help you feel better. G. Sexuality Cancer and cancer treatment can affect your desire for sex. It can also affect your sexual functioning. Talk to your radiation oncologist or oncology nurse if you or your partner has any questions about how the treatment affects your sexuality. H. Other side effects It is possible that you will have other side effects that are not described above. The side effects you learn about in this booklet are the most common. Talk to your treatment team if you experience other symptoms during your treatment. Sometimes the tumor and the treatment can cause very similar symptoms. What to Expect After Radiation Treatment The side effects that you feel from the treatment are temporary. You will start to feel better about 1 to 2 weeks after your treatment is finished. Near the end of your radiation treatment, you will be given a booklet What to Do When Finishing Radiation therapy. You will meet with a radiation oncologist on the last week of your treatment. He or she will then give you the final review of your treatment. You can prepare a list of questions and bring it to this appointment. After your final review appointment, you will be scheduled for a follow-up appointment at Princess Margaret Hospital. This is usually planned for 1 to 3 months after your treatment is finished. At this appointment, you will find out how you have responded to the treatment and the team will make sure that your side effects have gotten better. 8

Things That May Happen After Radiation Therapy A. New Symptoms The radiation treatment side effects mentioned above are temporary. They should start to get better 1 to 2 weeks after your radiation treatment is done. You can start some of your normal routines at this time. Sometimes, people will develop new side effects after their radiation treatment is finished. Talk to your radiation oncologist or oncology nurse if you develop new symptoms after your radiation treatment is finished. B. Brachytherapy Some people may need internal radiation treatment right after completing external radiation treatment. This is called brachytherapy. Your radiation oncologist will let you know if you need brachytherapy. They will talk to you about this before your last day of external radiation. C. Narrowing of the Vagina Sometimes radiation treatment to the pelvis can cause the vagina to narrow. Your treatment team will let you know what you can do to help reduce the chance that this will happen. You may need to use a vaginal dilator if the team expects that your vagina may narrow. Your treatment team will tell you how to use the dilator correctly. You should use the dilator for 3 to 6 months, or as recommended by your radiation oncologist. Sometimes you may even need to use it for longer. Your radiation oncologist can teach you how to use the dilator at your regular clinic visits after your radiation treatment is finished. Learn More with These Resources Find these pamphlets at the Patient & Family Library (Main Floor), and the Patient Family Resource Centres located in the waiting rooms on Levels 1B and 2B. Your Radiation Therapy at The Princess Margaret Hospital (2011) Radiation Therapy and You. (2006) Canadian Cancer Society What you need to know about antioxidants and your Radiation Therapy pamphlet (2010) Guidelines for Managing Gas pamphlet (2010) Eating Hints For People with Diarrhea pamphlet (2010) Having a Sitz Bath at Home pamphlet (2011) Contact or visit the Patient & Family Library to find more information: 9

Location: Princess Margaret Hospital, Main Floor Telephone: (416) 946-4501 ext. 5383 Email: patienteducationpmh@uhn.on.ca Website: http://www.uhn.ca/pmh/services/library.asp You can also visit the University Health Network Patient Education website at www.uhnpatienteducation.ca Find information about all the UHN Patient Patient & Family Library & Resource Centres at www.uhn.ca/patients_&_visitors/health_info/topics/patient_family_library/index.asp Write Your Notes Here: 10