Finger Lakes Radiation Oncology Center in Upstate NY

Frequently Asked Questions about Cancer and Cancer Treatment

What is Cancer?

Unregulated cell growth.

Hyperplasia
- There is crowding, but all the cells are normal.
Atypical hyperplasia
- There is crowding and the cells are starting to look abnormal.
Metaplasia
- The cells are looking more like tissue in another organ.
  - Example: “Barrett’s” esophagus in which the lining of the esophagus looks like the lining of the stomach.
Carcinoma in situ
- The cells are abnormal and their organization is also abnormal but the cancer has not invaded into underlying tissue.
  - Think of the difference between a little rust on a car and a rusty hole through the sheet metal.
Invasiveness
- Malignant tumors can grow through the normal boundaries between one organ or tissue and another.
  - Malignant tumors can grow into blood or lymphatic vessels or nerves within the tumor.
Metastasis
- Malignant cells enter the lymphatic system or bloodstream and colonies start growing in other organs or tissues.
  - Cancer cells can be found in the bloodstream in patients who never develop clinical metastases. It is thought that different cancer cells require different environments to start a metastasis. Some cancer cells can travel beyond their origin but lack the genetic equipment to reproduce in a foreign tissue.
- In most cases the presence of metastases to lymph nodes means that there is a high risk of the cancer also spreading through the bloodstream
  - This is why chemotherapy is used in patients with breast or colorectal cancers with multiple involved lymph node.

What should I do if I have been diagnosed with cancer, and would like to seek treatment at the Finger Lakes Radiation Oncology Center?

Please call us at (315) 462-5711 and our staff can guide you through the referral process.

How is a diagnosis of cancer made?

Screening tests
- Mammography
- PAP smear
- Rectal exam
- PSA screening
Symptoms
- Mass
- Suspicious skin lesion
- Unexplained bleeding
- Sores in the mouth or throat
- Unexplained changes in bowel function
- Cough or shortness of breath
- Unexplained pain
- Unexplained weight loss, loss of appetite
- Any unexplained changes in body function which get worse rather than better

How is a diagnosis of cancer confirmed?

A biopsy is done using a method determined by the location of the suspicious finding.

What tests are done once a patient is known to have cancer?

CT, MRI, bone scan, PET scan, endoscopy or other procedures may be done to determine staging. “Staging” refers to any tests done to determine the local extent of disease and whether it has spread. Most malignancies have typical patterns of spread, and the recommendations for staging procedures vary by site.

What determines the choice of treatment?

Surgery, radiation therapy, chemotherapy, and hormonal manipulation are the key forms of treatment.

Surgery and radiation therapy are used for control of localized disease.
Chemotherapy and hormonal treatment are used in patients who have or are at risk for widespread disease.

These forms of treatment may be used in combination; this has become more common within the past few years because multiple modality treatment is often more effective. Radiation alone can be used for cure of some cancers or symptom relief (palliation) in more advanced cases.

There are published standards of practice which give recommendations by disease site. Prior experience and discussion with other physicians influence the recommendation for treatment.

How is a prognosis determined?

Extent of disease
Condition of patient
Type of cancer
Response to treatment
A prognosis is only an educated guess

What does “terminal” mean?

“Terminal” usually means that it’s obvious that the patient’s life expectancy is short. We seldom use this word in this facility because a doctor’s prediction of life expectancy is only an estimate.

“Incurable” does not necessarily mean “terminal”.

“Treatable” does not necessarily mean “curable”.

What do patients and their families deserve?

Excellent clinical care
Emotional support
Information about their disease and care in language they can understand
Honesty with compassion in discussions (candor need not be cruel)

What is radiation?

Visible light, infrared and ultraviolet light, and radio waves are other familiar forms of electromagnetic radiation.
High energy X-rays are electromagnetic radiation produced by machines called linear accelerators.
High energy X-rays are similar to diagnostic X-rays but the difference between the two is like comparing a fire hose to a squirt gun.
Electrons are particles also produced by linear accelerators. Electrons only treat to a shallow depth, while high energy X rays can treat to a greater depth in the body.

How does radiation work?

Radiation works via 2 routes, directly and indirectly.
X rays directly strike cancer cells and cause irreparable damage.
Radiation works indirectly by producing ions and free radicals which are highly reactive and alter the DNA in cell nuclei, causing cell death.
It is important to know that normal cells and tissues can repair radiation damage much better than cancer cells.

How is radiation given?

There are several ways to administer radiation:

External beam treatment is delivered with a linear accelerator.
“Brachytherapy” Refers to radiation sources applied within the body .
- Intracavitary treatment is used for gynecologic cancers- radioactive material is placed temporarily inside instruments inserted into the patient’s vagina and uterus.
- Interstitial treatment is used for prostate cancer- radioactive pellets or seeds (which look like a metallic grain of rice) are permanently implanted within the prostate gland.
Radioisotope therapy
- I-131 (radioactive iodine) for hyperthyroidism and thyroid cancer
- Sm-153 (radioactive samarium) for metastatic bone disease

How is a radiation oncologist different from a medical oncologist?

A medical oncologist (chemotherapy doctor) usually has 3 years of internal medicine residency followed by 3 or 4 years of specialty training in the treatment of cancer and blood disorders. A medical oncologist is certified by the American Board of Internal Medicine.

A radiation oncologist goes through a minimum of 5 years of training in a program which includes extensive training in radiation physics and radiation biology as well as intensive clinical experience in the evaluation and treatment of cancer patients. Radiation oncology residencies are completely separate from diagnostic radiology residencies. A radiation oncologist is certified by the American Board of Radiology.

What is a medical physicist?

The essential responsibility of the medical physicist’s clinical practice is to assure the safe and effective delivery of radiation to achieve a therapeutic result as prescribed by the radiation oncologist.
Medical physicists collaborate with radiation oncologists to design treatment plans using either external radiation beams or internal radiation sources, and monitor equipment and procedures to insure that cancer patients receive the prescribed dose of radiation.
The responsibilities of the medical physicist include: the measurement and characterization of radiation; the determination of delivered dose; and development and direction of quality assurance programs.
Medical physicists have a Master’s or Ph.D. degree in medical physics, physics, radiation biology, or a related discipline, and training in clinical medical physics.
The American Board of Radiology certifies medical physicists, as does the American Board of Medical Physics.

What is a radiation therapist and how do radiation therapists differ from X-ray technologists?

Radiation therapists are:
- Licensed medical professionals trained to actually administer the radiation treatments prescribed by the doctor. Therapists are responsible for accurately positioning the patient daily and operating the treatment machines.
X-ray technologists (radiographers) are:
- Trained to obtain high quality images such as x-rays and CT scans.

The training programs are very different. Radiation therapists complete a 4 year program of classroom study and clinical training. Subjects include physics, anatomy, radiation biology, and oncology. After completion of training, graduates have to pass a board exam given by the ASRT (American Society of Radiation Technologists) to obtain licensure.

What is a medical dosimetrist?

A medical dosimetrist is a radiation therapist with at least 2 years additional training in radiation treatment planning. Treatment planning computer software is used to develop a treatment plan which delivers the prescribed radiation dose to the target while sparing normal structures.

Medical dosimetrists are certified by the American Association of Medical Dosimetry after passing a board exam.

What is the role of nurses in a radiation therapy department?

The nursing staff’s role in the radiation oncology department is multifaceted.

Qualifications: New York State requires at least one Registered Nurse (RN) in a radiation clinic. Other nursing staff may consist of RNs and Licensed Practical Nurses (LPNs).
Training specific to Oncology: On the job training is required as for any nursing specialty.
Duties:
- Assessment
  - Assesses patients psycho-social, spiritual, and medical needs before and during treatment.
- Implementation
  - Provides support and encouragement during treatment.
  - Acts as the patient’s advocate.
  - Anticipates the various side effects caused by treatment and provides the appropriate care to keep patients comfortable through treatment.
  - May refer patient for spiritual or psychological counseling with doctor’s approval.
  - May refer patient for home care assistance with doctor’s approval.
- Evaluation
  - Continually evaluates patients needs throughout treatment since patients needs may change as they progress through their course of radiation.
- Education

Is radiation therapy dangerous?

Any medical procedure has potential side effects and complications.
Modern techniques, however, greatly reduce the risk of long term complications.
Normal tissues can be shielded.
Computerized planning allows very precise depictions of the actual doses of radiation which the patient receives.
Benefits and risks of the proposed treatment are carefully reviewed with the patient and consent is obtained before treatment is started.

What does a radiation treatment feel like?

The patient lies on a hard table because a soft mattress would make it impossible to accurately position a patient exactly the same way every day.
Carefully selected headrests, positioning devices, and cushions make the patient more comfortable and make it easier to stay still in the correct position.
Custom plastic masks are used to hold the head still if we are treating the head.
Custom cushions under the thighs and legs are often used for patients treated for prostate cancer.
The therapists help the patient get on and off the table and get the patient into the correct position for treatment.
Our staff is very skilled at assisting patients safely and comfortably
The therapists leave the room (for their safety) for about a minute when the radiation beam is on.
We use a closed circuit TV and sound system to keep a close eye and ear on the patient while they are alone in the room.
We have a selection of audio CDs which help patients feel more comfortable, or patients may bring their own if they prefer.
The machine will make noise. This is generally minimal, but patients receiving IMRT radiation may need earplugs as this technique makes louder, tapping sounds.
Daily ultrasound pictures can be taken for some patients receiving radiation to the prostate to ensure accuracy.
Patients sometimes say they feel some warmth or smell a strange odor. This is normal but most patients do not feel or smell anything.

Why might radiation be recommended instead of surgery or chemotherapy?

Radiation is used for treatment in a specific area.
Radiation may be used if it will prevent removal of an organ or if surgery is not an option or if surgery will result in unnecessary disfigurement.
Radiation may be given if there is a risk that cancer cells may be left behind after surgery.
Chemotherapy travels throughout the whole body. It may be used if the patient has spread of cancer to other sites or if there is a risk of spread.
Chemotherapy is sometimes used to increase the effectiveness of radiation.
Combinations of radiation, surgery, and chemotherapy are very frequently used.

What are common circumstances in which radiation is given?

Radiation for cure
Radiation for palliation (relief of symptoms)
- Metastasis (spread) to bone, brain or other areas
- Treatment of masses which have come back after surgery
Preventative Radiation
- Hip replacement (at time of surgery to prevent abnormal bone growth around the replacement hip)

What areas are most commonly treated with radiation?

Prostate
Breast
Lung
Cancers of the Head & Neck
Gynecologic cancers
Colon/rectal cancers
Lymphomas
Esophagus
Stomach
Pancreas
Skin cancers
Brain

How many treatments are given?

Curative treatment courses usually range between 30 and 40 treatments given 5 days a week.
Palliative treatment courses usually range between 10 and 20 treatments.

What is IMRT?

IMRT stands for “intensity modulated radiation therapy”.
Computer controlled equipment changes the shape of the radiation beam continuously while treatment is given.
Different doses can be delivered to different structures at the same time, which allows the radiation oncologist to treat the cancer at a high dose and spare surrounding normal structures.
Higher doses can be delivered to the cancer with a lower risk of complications.
We use IMRT mostly for treatment of patients with cancers of the head and neck and patients with prostate cancer.

How is treatment planned?

Consultation
- The radiation oncologist reviews the patient’s records and x-rays, interviews and examines the patient, and makes recommendation for treatment.
- Additional x-rays or other procedures may be necessary.
- The radiation oncologist often discusses the patient with other physicians involved in the case.
Simulation
- Under the direction of the radiation oncologist, the radiation therapist develops a reproducible treatment position.
- Reference marks are placed on the patient’s skin.
- X-rays and a treatment planning CT scan are done.
- The CT is electronically transferred to the planning computer. Any of the patient’s previous CT scans cannot be used for planning because the patient is not in the treatment position.
- The radiation oncologist designates the structures which require treatment.
Computerized planning
- Most patients are treated with complex techniques involving multiple treatment directions and sometimes different beam energies.
- 3D treatment planning programs display the exact distribution of radiation in the patient’s body.
- The dosimetrist, radiation physicist, and radiation oncologist can try a variety of approaches which deliver a high dose of radiation to the tumor while keeping dose to normal structures low enough to prevent complications.
- Planning for IMRT is done with a dedicated planning system. Inverse Treatment Planning differs from standard planning because the physicist or dosimetrist determines the desired dose for each structure and the computer evaluates thousands of combination of beam sizes and directions to meet these goals.

Does the radiation oncologist coordinate care with other physicians caring for the patient?

Copies of all our office notes are sent to all physicians involved in the patient’s care.
The radiation oncologist discusses the case with the referring physician if there are any concerns or if this will help in making a recommendation.

Are there side effects of radiation?

The type of side effects a patient develops depends on the part of the body being treated.
Side effects generally start slowly and may become more severe as the course of treatment proceeds.
Some patients may get more severe side effects than other patients even if the treatment is similar.
The radiation oncologist and nurse review the expected side effects with the patient before treatment begins and work closely with the patient during the treatment course to manage them.

What are the most common side effects of radiation during treatment?

Side effects occur only in the part of the body that is treated.
Many people are able to continue their normal daily activities throughout treatment. This includes being able to drive themselves to their appointments.
With modern techniques and dosing schedules, side effects have greatly diminished over the years.
Reddening of the skin, similar to a sunburn.
Fatigue (usually does not interfere with normal activity).
Diarrhea is a common side effect of pelvic (including prostate, rectal and gynecological) radiation.
Sore throat and changes in taste are both common side effects of neck and chest radiation.
Hair loss is not usually associated with radiation treatment unless the head is directly treated.
Nausea is not a typical side effect of radiation, but is possible with treatment to the abdomen.

Am I radioactive?

Patients receiving external beam treatments are not radioactive at any time and there are no precautions necessary.
Patients that receive brachytherapy may be radioactive and necessary precautions are explained before treatment.

Are there long term effects of radiation?

Like the side-effects during treatment, potential complications depend on the part of the body being treated.
Treatment doses and techniques are selected to minimize the risk of major complications.
A slight thickening of the skin or underlying tissues (fibrosis) of the treated area occurs sometimes. This is not usually noticeable and often does not cause discomfort.
Dry mouth (xerostomia) and changes in taste often last long past the end of radiation treatment.
Potential complications are fully discussed with each patient before a treatment course begins.
One reason that radiation oncologists follow patients after treatment is done is that complications may develop years after treatment.

Can radiation cause cancer?

With modern techniques and dosing schedules, radiation induced cancers are extremely rare. Patients who received radiation in 1960’s and before, may have increased risk of developing these cancers.

Is radiation ever used for benign disease?

There are only a few conditions for which radiation is used for benign disease

Radiation is used for some patients undergoing hip replacement to prevent abnormal bone growth.
Radioactive iodine is very commonly used for patients with hyperthyroidism.

When can a patient know that the radiation is working?

If a patient is being treated for symptom relief or a visible mass, improvement is often seen by the end of treatment.
A repeat planning CT is sometimes needed to plan the final phase of treatment. When this shows improvement we let the patient know.
X-rays are not usually ordered to assess response until some time after treatment is completed.
In patients treated for prostate cancer the PSA will usually start going down within a few months after treatment.
In many cases it is only possible to know that the treatment has worked because there is no sign of disease recurrence years after treatment is complete.

Does insurance cover radiation treatments?

Most insurance policies cover the bulk of expenses, but deductibles and co pays vary with the individual plan.
We work out a payment plan for any uncovered charges.