Treatment by Cancer Type
Radiation therapy is often prescribed to treat cancer. It may be used alone or with chemotherapy, depending upon the type of cancer and location within the body.
- With external radiation therapy—also called radiotherapy— a machine called a linear accelerator (or "linac") targets a beam of radiation at the cancer site from outside the body. The radiation beam is painless and treatment itself lasts only a few minutes. Treatment is delivered on a daily basis (weekdays) over the course of a number of weeks.
- With internal radiation therapy—also called "brachytherapy" [brake-ee-THER-uh-pee])—a radioactive implant(s) is placed very close to or inside the tumor. The implant(s) may reside permanently inside the patient or may be removed at a later time. Treatment may require a hospital stay.
Learn more about types of radiation therapies and about chemotherapy.
Following breast-conserving surgery (lumpectomy), radiation therapy is commonly prescribed to treat the breast and, in certain cases, nearby lymph node areas.
What to Expect
- Treatment is delivered every day, five days a week, Monday through Friday and usually over a period of three to seven weeks.
- Before beginning treatment, you will be scheduled for a planning session (a procedure called a "simulation") to map out the area to be treated.This involves X-rays and/or a CT scan. You may also receive tiny marks on your skin, which becomes a permanent tattoo, to help the radiation therapist precisely position you for daily treatment.
- Typically, radiation therapy is done with high energy X-rays, or photons, for the bulk of treatment. When there is a reason to focus the radiation where the lump was taken out, a less-penetrating, more focused beam of electrons may be given as a "boost".
- Different techniques may be used as radiation therapy to treat for breast cancer:
- Three-dimensional conformal radiotherapy (or 3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and chest wall while sparing nearby normal tissue.
- Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of each radiation beam. Doctors are still studying IMRT for the treatment of some types of breast cancer. Talk with your radiation oncologist for more information about the details of your treatment plan. Recent clinical trials suggest that treatment with whole breast radiation may be shortened by treating with higher daily does to finish in less time. Ask your doctor for details about the right dose and schedule for your case.
What to Expect
- External beam radiation therapy is usually used to treat bladder cancer, often in combination with chemotherapy.
- Internal radiation, or "brachytherapy", may also be used—often in conjunction with external beam radiation therapy. Radioactive pellets or seeds are delivered to the tumor through small tubes (catheters) to damage cancer cells and their ability to multiply. When these cells die, the body naturally elimates them.
For cancer that has metastasized or spread through the bones, the treatment goal is to control pain or other symptoms and improve your quality of life. In some cases, these treatments can also help you live longer with your cancer.
What to Expect
- Your doctor may prescribe medicines called bisphosphonates. These drugs slow the bone loss caused by cancer to reduce the risk of bone fracture and pain.
- Your natural hormones can sometimes encourage cancer cells to grow. For example, in women, the hormone estrogen can help some breast cancers grow. Your doctor may prescribe hormone therapy to reduce your hormone levels and try to stop the bone tumor from growing.
- To shrink the tumor and decrease pain, radiation therapy is applied using high-energy X-rays to injure and destroy cancer cells.After finishing radiation therapy, it may take one or more weeks to notice the full benefits of the treatment.
- In selected circumstances, your doctor will place a radioactive substance (called a radiopharmaceutical) into your bloodstream to attack cancer cells in all bones.If the cancer is likely to break a bone or the tumor causes pressure on your spinal cord, your doctor may recommend surgery before radiation with the goal of providing more relief from symptoms and preserving normal function.
- In most cases, treatment for bone metastases does not “cure” your cancer. However, modern treatments allow doctors to control the bone metastases, allowing many patients to improve quality of life and to live months or years longer. This time depends more on where the original cancer started, where it has spread and how well it responds to treatments rather than on the actual number of bone metastases.
Brain Cancer (Metastatic)
Treatment for cancer that has metastasized or spread to the brain focuses on controlling pain or other symptoms to improve your quality of life. In some cases, these treatments can also help you live longer with your cancer.
What to Expect
- External beam radiation therapy is administered on an outpatient basis. When the whole brain needs radiation treatments, treatments are usually given daily, Monday through Friday. In some cases, a single, high-dose radiation treatment called stereotactic radiosurgery can be completed in one day to target a small part of the brain. In other cases, a combination of both stereotactic radiosurgery and whole brain radiation therapy can be helpful.
- Before starting radiation, you will undergo a radiation simulation or “planning” session, during which you will be fitted with a custom-fit, mesh mask that helps to keep you immobilized and in the proper position during your treatment. This procedure also involves a CT Scan.
Depending on your tumor, you may need to undergo surgery and/or chemotherapy before or after radiation.
What to Expect
- There are three types of external radiation therapy that may be used:
- Three-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the brain. Tailoring each of the radiation beams to the patient's tumor allows coverage of the diseased cells while keeping radiation away from nearby organs, such as the eyes.
- Intensity modulated radiation therapy (IMRT) is the most recent advance in the delivery of radiation. IMRT differs from 3D-CRT by modifying the intensity of the radiation within each of the radiation beams.
- Stereotactic radiotherapy, sometimes called radiosurgery, is a type of external beam radiation therapy that pinpoints high doses of radiation directly on the tumor, in some cases in only one treatment.
Colon, Rectum and Anus Cancers
Colon Cancer: The primary treatment for colon cancer is surgery. Your doctor may also recommend radiation therapy and/or chemotherapy, depending on the location and stage of your cancer.
Rectal Cancer: For some rectal cancers, radiation therapy is given with chemotherapy to reduce the tumor size so it can be removed more easily during surgery. Other times, radiation is given after surgery to keep the cancer from returning.
Anal cancer: can often be treated with just radiation therapy and chemotherapy, no surgery.
What to Expect
External radiation therapy is often used to treat cancers of the colon, rectum and anus, in conjunction with surgery and chemotherapy.
- Radiation therapy involves a series of daily outpatient treatments.
- Before beginning treatment, you will be scheduled for a simulation to map out the area to be treated. This will involve having X-rays and/or a CT scan. Landmarks placed on your skin (typically tiny tattoos) to enable the radiation therapists delivering your treatments to precisely position you each day.
- To minimize side effects, treatments are given gradually over a period of about six weeks, five days a week (Monday through Friday). This schedule kills tumor cells while allowing healthy cells time to recover each day.
- Colorectal and anal cancer may be treated with three-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT) or image guided radiation therapy (IGRT). Your radiation oncologist can provide more information on these different techniques.
What to Expect
External Beam Radiation Therapy
- Radiation therapy is usually given in a series of daily sessions, each taking less than half an hour, Monday through Friday, for approximately five to six weeks.
- Three-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the affected area. Tailoring each of the radiation beams to focus on the tumor delivers a high dose of radiation to the tumor and avoids nearby healthy tissue.
- Intensity modulated radiation therapy (IMRT) is the most recent advance in the delivery of radiation. IMRT improves on 3D-CRT by modifying the intensity of the radiation within each of the radiation beams. This allows more precise adjustment of radiation doses to the tissues within the target area.
Internal Radiation Therapy
- Internal radiation therapy involves placing radioactive sources in or next to the cancer. Brachytherapy is very important in the treatment of vaginal, cervical and uterine cancers. Depending upon the situation, internal treatment may be given either in conjunction with external beam radiation therapy or by itself.
- Low-dose-rate brachytherapy is delivered over the course of 48 to 72 hours. You will be admitted into the hospital to receive this treatment.
- High-dose-rate brachytherapy does not usually require you be admitted to the hospital. The entire procedure typically takes a few hours. In some simple cases, treatment can take less than an hour. Depending of the type of cancer you have, you may need to have several sessions of brachytherapy.
Head and Neck Cancers
Treatment for head and neck cancer depends on several factors, including the type of cancer, its size and stage, its location and your overall health. Surgery, radiation therapy and chemotherapy are the mainstays of treating head and neck cancers.
For many head and neck cancers, combining two or three types of treatment may be most effective. That is why it is advised to talk to several cancer specialists about your care, including a surgeon, a radiation oncologist and a medical oncologist.
An important consideration in treating head and neck cancers is organ preservation, in order, for example, to preserve natural functions such as your ability to smell, chew or taste food. An organ preservation approach uses radiation and sometimes chemotherapy to shrink or completely eliminate the tumor. This can allow some patients to avoid surgery.
What to Expect
- Treatments are usually scheduled Monday through Friday, for five to eight weeks. The time will depend on your treatment plan and type of cancer.
- To help you keep still during treatment, you will be fitted with a custom-made, mesh mask that will cover your head and shoulders. This device has holes so you can see and breathe through it. It is designed to fit snugly on you.
- Radiation therapy may be administered in two, targeted forms that help avoid healthy tissue and may help avoid side effects like changes in your saliva:
- Three-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the affected area.
- Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of each radiation beam. This allows a precise adjustment of radiation doses to the tissue within the target area.
Lung cancer treatment depends on several factors, including the type and stage of the lung cancer and your overall health. The main treatment options are surgery, radiation therapy and chemotherapy. New treatments are also showing promise.
What to Expect
Non-small cell lung cancer (NSCLC):
- Non-small cell lung cancer can be treated with surgery, radiation therapy and/or chemotherapy.
- Stage I NSCLC (small tumor in the middle of the lung) is primarily treated with surgery. For patients who for health reasons cannot undergo surgery, stereotactic body radiation therapy (a targeted, single, high-dose of radiation) may be an excellent alternative. It is non-invasive and is usually given in one to five treatments.
- Stage II NSCLC (larger tumors, extension outside of the lung itself, or early involvement of lymph nodes) is treated with surgery, followed by chemotherapy. Stereotactic body radiation therapy has not been well-studied for these tumors, and conventional external beam radiation therapy would commonly be recommended for patients who, for health reasons, cannot undergo surgery.
- Stage III NSCLC (tumor extending into other organs or involvement of lymph nodes in the middle of the chest) can be treated in several different ways. For some patients, initial chemotherapy—or chemoradiation therapy followed by surgery—is a reasonable approach. For other patients, definitive chemoradiation therapy without surgery is preferred. The radiation typically takes six to several weeks.
- Stage IV NSCLC (tumor has spread from the lungs, and involves other locations such as the brain, the bone or the liver) is usually treated with chemotherapy. Radiation therapy is used for local control of tumor to prevent symptoms such as pain or neurological dysfunction similar to stroke, and typically lasts one to two weeks.
Small cell lung cancer (SCLC):
- Small cell lung cancer most often is treated with radiation therapy and chemotherapy.
- Limited stage SCLC is disease confined to the chest. It roughly corresponds to Stage I-III for NSCLC above. It is primarily treated with simultaneous chemotherapy and radiation to the chest. Because there is a high rate of microscopic tumor deposits to the brain, giving radiation therapy to the brain (prophylactic cranial irradiation) is frequently offered after completion of the primary chemoradiation therapy to the chest. This is to kill any tiny cancer cells that may have spread to the brain.
- Extensive stage SCLC is metastatic disease, and corresponds to Stage IV NSCLC above. It is primarily treated with chemotherapy. Radiation therapy is used for local control of tumor.
Treatment options depend on the type of lymphoma, its stage and your overall health. Treatment may include chemotherapy or radiation therapy, either alone or in combination.
What to Expect
External Beam Radiation Therapy delivered in a series of outpatient treatments has been proven to be very successful at treating and curing lymphoma.
- Daily (weekday) treatments last less than 30 minutes each and are scheduled over several weeks.
- Areas treated are generally classified as follows:
- Involved field radiation: radiation is delivered only to the parts of your body known to have the disease. It is often combined with chemotherapy.
- Mantle field radiation: radiation above the diaphragm to the neck, chest and/or under arms.
- Inverted-Y field radiation: treatment below the diaphragm to the abdomen, spleen and/or pelvis.
Facts About Prostate Cancer
- Prostate cancer is the most common cancer in American men.
- The American Cancer Society estimates that one in every six men will develop prostate cancer in his lifetime
- According to the American Cancer Society, about 186,000 men were diagnosed with prostate cancer in 2008. Prostate cancer is very manageable and often curable. More than 98 percent of men with prostate cancer will live at least five years after diagnosis.
What to Expect
- External beam radiation therapy involves a series of daily treatments to accurately deliver radiation to the prostate. There are several ways to deliver external beam radiation. Recently completed research trials have shown that increasing the dose of radiation can be done safely with improvement in outcome and avoidance of significant side effects.
- Before treatment, you will have a scan to allow the radiation oncologist to target the radiation on the cancer. Usually several radiation beams are combined to shape, or “conform”, the radiation to the prostate cancer. This technique is called three-dimensional conformal radiation therapy or 3D-CRT. Tailoring each of the radiation beams to accurately focus on the tumor allows doctors to target the prostate cancer while keeping radiation away from nearby organs such as the bladder or rectum.
- Some doctors use a type of 3D-CRT called intensity modulated radiation therapy or IMRT that changes the intensity of the radiation within each of the radiation beams, allowing doctors to safely increase the amount of radiation to the prostate. Image-guided radiation therapy (IGRT), a technique using direct visualization of the prostate anatomy, may also be used before each daily treatment.
- With external beam therapy, painless radiation treatments are delivered in a series of daily sessions, Monday through Friday, for six to 10 weeks. The duration of your treatment will depend on your health and the type of radiation used.
- Prostate Brachytherapy involves treating the cancer by inserting radioactive "seeds" directly into the gland. This is usually the only radiation therapy you will need, but it is occasionally combined with external radiation.
- Temporary or permanent seed implants (low-dose-rate "LDR" brachytherapy) are given by inserting small metal seeds of radioactive iodine or palladium directly into the prostate gland. You will be under anesthesia during this brief outpatient surgery procedure. (Outpatient surgery means you can go home shortly after surgery.) The seeds are temporarily radioactive and deliver the radiation to the prostate over several weeks.
- The seeds are then harmless and should not bother you. For the short time that the seeds are giving off radiation, men are asked not to be in close proximity to children or pregnant women because of the very small chance that the radiation may harm their rapidly growing bodies. Ask your radiation oncologist or oncology nurse if you need more specific instructions or if you have any concerns about pets or family members.
- High-dose-rate (HDR) prostate implants deliver radiation to the prostate with a few treatments using a single small radioactive iridium source on the end of a computer controlled flexible wire. The radiation is given through narrow tubes called catheters inserted into the prostate by your radiation oncologist. You will be under anesthesia and will not feel any pain. The tubes remain in place for only one or two days. Once the treatment is complete, the tubes and the radioactive source are taken out. After this type of radiation, you will not need to take special precautions around others.
- Hormone Therapy: Depending on your cancer, you may benefit from adding hormone therapy to radiation.
- Hormone therapy may be given by your radiation oncologist, medical oncologist or urologist.
- It may be used together with radiation therapy or before radiation to shrink the tumor.
- The length of time you will receive hormone therapy depends on the cancer. Ask your doctor for more information. Side effects of hormone therapy may include hot flashes, mild breast tenderness, diarrhea, nausea and tiredness.
The treatment you receive depends on several factors, including what type of skin cancer you have, your overall health, stage of the disease and whether the cancer has spread to other parts of your body.
What to Expect
- Because melanoma can be highly aggressive, surgery to remove a wide area is usually the primary treatment option.
- Melanoma can spread into the surrounding lymph nodes, which are the tissue draining stations. In most instances, the surgeon will biopsy or remove these lymph nodes.
- If there is a concern that the surgeon might not have been able to remove all of the disease, radiation therapy is sometimes recommended after surgery for either the primary site or for the lymph nodes. Talk to your radiation oncologist to see if radiation would be right for you.
- Interferon therapy, which is a type of biologic therapy, is sometimes offered, if there is concern that your melanoma has a high risk of developing distant (metastatic) disease. You will want to talk to a medical oncologist, a doctor who prescribes chemotherapy, about these issues in more detail.
Basal cell cancer and squamous cell cancer:
- These tumors are typically not as aggressive as melanoma, and there are many treatment options available.
- Surgical excision may be used, particularly Mohs Surgery (MMS), which is a special surgical approach using microscopic evaluation to map and remove all of the cancerous tissues, while preserving as much healthy tissue as possible
- Curettage and electrodessication (C and D, EDC) is typically used for smaller lesions (less than one centimeter). The cancer is dried with an electric current and removed.
- Cryosurgery is also used for small lesions that are not deep (this is called superficial). The cancer cells are frozen and eventually rub off naturally.
- Laser surgery can be used for superficial lesions. This is when cancer cells are destroyed by laser beams.
- Radiation therapy is an effective treatment often used for skin cancers where surgery or other localized therapies might cause functional or cosmetic defects.
- Photodynamic therapy (PDT) is primarily used in the treatment of actinic keratosis. It uses a drug that is very sensitive to a special kind of light. This drug is topically applied to the lesion. When exposed to that special light, the drug produces a chemical reaction that kills the cancer cells.
- Topical therapy is an application of a drug cream (Imiquimod or 5-FU) over the tumor. These drugs then locally kill the cancer cells.
- Sometimes a combination of approaches may be used, such as surgical excision followed by radiation therapy, if there is a concern that the surgeon may not have completely removed all of the tumor.