RADIATION THERAPY
Content
CANDO, Precious Gia G. August 17, 2010
NCM-105L AFPMC
Prof. Dawn Capaque
RADIATION THERAPY, NURSING CARE I. Assessment of the situation A A.. Definition The therapeutic use of radium, radon, radioactive gold and other radioactive substances subs tances to kill malignant cells, requiring special nursing care and consideration. B. Rationales for actions 1. To prolong life by destroying malignant cells. 2. To aid in the patients comfort. 3. To cause partial or complete remission of the malignant process. II. Nursing Plan A A.. Objectives 1. To maintain a calm and reassuring r eassuring manner. 2. To prepare the client adequately for the impressive size of the machinery use in cobalt therapy and for possible side effects. 3. To maintain optimistic outlook. 4. To treat side effects and minimize discomfort. 5. To take adequate precautions to protect staffs, visitors and other clients from the harmful effects of radiation. B. Patient preparation 1. The machinery used to administer cobalt 60 is massive and may frighten the patient. For their own protection, the personnel pers onnel stand behind a lead screen or wall during the treatment. For these reasons, the patient could find f ind his first cobalt-60 treatment a terrifying experience. Client must be adequately prepared in advance for the first f irst sight of the equipment and for the fact that she will be left alone. The nurse should explain that there is no pain or sensation involved. Prior positive preparation can do much to help the patient accept these treatments. 2. The patient should understand the reason for f or and expected effects of the treatment before instigation. Before receiving a radioactive material, she should fully understand the care she will receive, visitor limitations and restriction on herself. 3. The patient should be told that she will not feel the rradiation adiation itself. She may have discomfort form the surgical implantation site; however there is no sensation in radiation treatments. C. Equipment Radiation Area sign. III. Implementing Nursing Intervention A A.. Therapeutic aspects 1. Cobalt-60 Therapy a. The cobalt-60 equipment is very large. There is no pain or sensation involvement on the actual treatment; however, after the initial treatment patient should be told that some side effects may occur; however, the nurse should avoid such statements as People always get nauseated from radiation therapy. The goal is to decrease the patients fear and anxiety if side effects do occur, not to increase her chances of having them by the power of suggestion. Usual side effects include nausea, vomiting, anorexia, skin reaction, malaise, and
CANDO, Precious Gia G. August 17, 2010
NCM-105L AFPMC
Prof. Dawn Capaque
alopecia. If skin reaction occurs, they must never be referred to as radiation burns, as this implies carelessness. They should be called dermatitis or skin reactions. B. Communicative Aspects 1. Observations a. Observe for any reaction r eaction to therapy, and treat early. A bland cream may help local skin reaction; vigorous rubbing should be discouraged. Anti-emetics help curb nausea. b. Observe the patients reaction r eaction to the treatment for signs of acceptance of the clinical diagnosis. c. Observe the patients environment (e,g., linens, floor) for any signs of dislodge radioactive materials. 2. Charting 3. Referrals C. Teaching Aspects- Patient and Family 1. Help the patients family and friends understand the restrictions when they face when visiting the patient. They will usually be more compliant if they know the reasons for these restrictions. However, avoid unduly alarming the patient or her visitors. 2. Familiarize other personnel with the radioactivity sign and symbol and the precautions to be taken. IV. Evaluation Process A. Did the patient face initiation of therapy calmly or with fear and apprehension? B. If side si de effects occurred was the patient prepared and did she react positively? C. Did side effects occur? Were they handled promptly and effectively? D. Were proper safety measures carried out by everyone who came in contact with the patient?
Reference: Illustrated Manual of Nursing Techniques, 2nd edition by King, Wieck and Dyer
CANDO, Precious Gia G. August 17, 2010
NCM-105L AFPMC
Prof. Dawn Capaque
Radiation Therapy apy Definition Radiation therapy, sometimes called radiotherapy, x-ray therapy radiation treatment, cobalt therapy, electron beam therapy, or irradiation uses high energy, penetrating waves or particles such as x rays, gamma rays, proton rays, or neutron rays to destroy cancer cells or keep them from reproducing. Purpose The purpose of radiation therapy is to kill or damage cancer cancer cells. Radiation therapy is a common form of cancer therapy. It is used in more than half of all cancer cases. Radiation therapy can be used:
alone to kill cancer before surgery to shrink a tumor and make it easier to remove during surgery to kill cancer cells that may remain in surrounding tissue after the surgery (called intraoperative radiation) after surgery to kill cancer cells remaining in the body to shrink an inoperable tumor in order to and reduce pain and improve quality of life. in combination with chemotherapy
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For some kinds of cancers such as early-stage Hodgkin's disease, non-Hodgkin's lymphoma, and certain types of prostate, pros tate, or brain cancer, radiation therapy alone may cure the disease. In other cases, radiation therapy used in conjunction w with ith surgery, chemotherapy, or both, increases survival rates over any of these therapies used alone. Precautions Radiation therapy does not make the person having the treatments radioactive. In almost all cases, the benefits of this therapy outweigh the risks. However radiation therapy can have has serious consequences, so anyone contemplating it should be sure understand why the treatment team believes it is the best possible treatment option for their cancer. Radiation therapy is often not appropriate for fo r pregnant women, because the radiation can damage the cells of the developing baby. Women who think they might be pregnant should shoul d discuss this with their doctor. Description Radiation therapy is a local treatment. tr eatment. It is painless. The radiation acts only on the part of the body that is exposed to the radiation. This is very different from chemotherapy in which drugs circulate throughout the whole body. There are two main types of radiation therapy. In external radiation therapy a beam of radiation is directed from outside the body at the cancer. In internal radiation therapy, called brachytherapy or implant therapy, where a source of radioactivity is surgically placed inside the body near the cancer.
How radiation therapy works
CANDO, Precious Gia G. August 17, 2010
NCM-105L AFPMC
Prof. Dawn Capaque
The protein that carries the code controlling control ling most activities in the cell is called deoxyribonucleic acid or DNA. When a cell divides, its DNA must also double and divide. High-energy radiation kills cells by damaging their DNA, thus blocking their ability to grow gr ow and increase in number. One of the characteristics of cancer cells is that they grow and divide faster than normal cells. This makes them particularly vulnerable to radiation. Radiation also damages normal cells, but because normal cells are growing more slowly, they are better able a ble to repair radiation r adiation damage than are cancer cells. In order or der to give normal cells time to heal and reduce side effects, radiation treatments are often given in small doses over a six or o r seven week period. External radiation therapy External radiation therapy is the most common kind of radiation therapy. It is usually done during outpatient visits to a hospital hos pital clinic and is usually covered by insurance. Once a doctor, called a radiation oncologist, determines the proper dose of rradiation adiation for a particular cancer, the dose is divided into smaller doses called fractions. One fraction is usually given each day, five days a week for six to seven weeks. However, each radiation plan is individualized depending depending on the type and location of the cancer and what other treatments tr eatments are also being used. The actual administration of the therapy usually takes about half an hour daily, although radiation is administered for only from one to five minutes at each session. It is is important to attend every scheduled treatment to get the most mos t benefit from radiation r adiation therapy. Recently, trials have begun to determine if there are ways to deliver radiation fractions so that they often.kill more cancer cells or have fewer side effects. Some trials use smaller doses given more The type of machines used to administer external radiation therapy and the material that provides the radiation vary depending on the type and location l ocation of the cancer. Generally, the patient puts on a hospital gown and lies down or sits in a special s pecial chair. chair. Parts of the body not receiving radiation are covered with special shields that block the rays. A technician then directs a beam of radiation to a pre-determined spot on the body where the cancer is located. The patient must stay still during the administration of the radiation so that no other parts of the body are affected. As an extra extr a precaution in some treatments, special molds are made to make sure the body is in the same position for each treatment. However, the treatment itself is painless, like having a bone x-rayed. Internal radiation therapy Internal radiation therapy is called brachytherapy, implant therapy, interstitial radiation, or intracavitary radiation. With internal radiation therapy, therapy, a bit of radioactive material is sealed in an implant (sometimes called a seed or capsule). The implant is then placed very close to the cancer. The advantage of internal radiation therapy is that it concentrates the radiation r adiation near the cancer and lessens the chance of damage to normal cells. Many different diff erent types of radioactive materials can be used us ed in the implant, including cesium, iridium, iodine, phosphorus, and palladium. How the implant is put near the cancer depends on the size and location of the cancer. Internal radiation therapy is used for some cancers of the head, neck, thyroid, breast, ffemale emale reproductive system, and prostate. Most people will have the radioactive capsule implanted by a surgeon while under either general or local anesthesia at a hospital or surgical clinic. Patients receiving internal radiation therapy do become temporarily radioactive. They must remain in the hospital during the time that the implant stays in place. The length of time is
CANDO, Precious Gia G. August 17, 2010
NCM-105L AFPMC
Prof. Dawn Capaque
determined by the type of cancer and the dose of radioactivity to be delivered. During the time the implant is in place, the patient will have to stay in bed and remain r emain reasonably still. While the implant is in place, the patient's contact with other people will be limited. Healthcare workers will make their visits as brief as possible to avoid exposure to radiation, and visitors, especially children and pregnant women, will be limited. l imited. The implant usually can be removed in a simple s imple procedure without an anesthetic. As soon as the implant is out of the body, the patient is no longer radioactive, and restrictions on being with other people are lifted. Generally people can return to a level of activity that feels comfortable to them as soon soo n as the implant is removed. r emoved. Occasionally Occasionally the site of the implant is sore for some time afterwards. This discomfort may limit specific activities. In some cases, an implant is left permanently inside the body. People who have permanent implants need to stay in the hospital and away from other people for the first few days. Gradually the radioactivity of the implant decreases, and it is safe to be around other people. Radioimmunotherapy Radioimmunotherapy Radioimmunothe rapy is a promising way to treat cancer that has spread (metastasized) to multiple locations throughout the body. Antibodies are immune system proteins that specifically recognize and bind to only one type of cell. They can be designed to bind only with a certain type of cancer cell. To carry carr y out radioimmunotherapy, radioimmunotherapy, antibodies with the ability to bind specifically to a patient's cancer cells are attached to radioactive material and injected into the patient's thesecell. man-made antibodies a cancer cell, bind ittocan it. be Then the bloodstream. radiation killsWhen the cancer This process is stillfind experimental, butthey because used to selectively attack only cancer cells, it holds promise for eliminating cancers that have spread beyond the primary tumor. Radiation used to treat cancer PHOTON RADIATION. Early radiation therapy used x rays like those used to take pictures of bones, or gamma rays. X rays and gamma rays are high energy rays composed of massless particles of energy (like light) called photons. The distinction between the two is that gamma rays originate from the decay of radioacive substances (like radium and cobalt-60), while x rays are generated by devices that excite electrons (such as cathode ray tubes and linear accelerators). These high energy rays act on cells by disrupting disr upting the electrons of atoms within the molecules inside cells, disrupting cell functions, and most importantly stop their ability to divide and RADIATION. make new cells. PARTICLE Particle radiation is radiation delivered by particles that have mass. Proton therapy has been used since the early 1990s. Proton rays consist of protons, a type of positively charged atomic particle, rather than photons, which have neither mass nor charge. Like x rays and gamma rays, r ays, proton rays disrupt cellular activity. The advantage of using proton rays is that they can be shaped to conform to the irregular shape of the tumor more precisely than x rays and gamma rays. They allow delivery of higher radiation doses to tumors without increasing damage to the surrounding tissue. Neutron therapy is another type of particle radiation. Neutron rays are very high-energy rays. They are composed of neutrons, which are particles with mass but no charge. The type of damage they cause to cells is much less likely to be repaired than that caused by x rays, gamma rays, or proton rays. Neutron therapy can treat larger l arger tumors than conventional radiation therapy. Conventional radiation therapy depends on the presence of oxygen o xygen to work. The center of llarge arge tumors lack sufficient oxygen to be susceptible to damage from conventional radiation. Neutron radiatio radiation n
CANDO, Precious Gia G. August 17, 2010
NCM-105L AFPMC
Prof. Dawn Capaque
works in the absence of oxygen, making it especially effective for the treatment of inoperable salivary gland tumors, bone cancers, and some kinds of advanced cancers of the pancreas, bladder, lung, prostate, and uterus. Recent advances in radiation therapy A newer mode of treating brain cancers with radiation therapy is known as stereotactic radiosurgery. As of the early 2000s, this approach is limited to treating cancers of the head and neck because only these parts of the body can be held completely still throughout the procedure. Stereotactic radiosurgery allows the doctor to deliver a single high-level dose of precisely directed radiation to the tumor without damaging nearby healthy brain tissue. The treatment is planned with the help of three-dimensional three-dimensional computer-aided analysis of CT and MRI scans. The patient's head and neck are held steady in a skeletal fixation device during the actual treatment. Stereotactic radiosurgery can be used in addition to standard s tandard surgery to treat a recurrent brain tumor, or in place of surgery if the tumor cannot be reached by standard surgical techniques. Two major forms of stereotactic s tereotactic radiosurgery are in use as of 2003. The gamma knife is a stationary machine that is most useful for small s mall tumors, blood vessels, or similar targets. Because it does not move, it can deliver a small, highly localized and precise beam of radiation. Gamma knife treatment is done all at once in a single hospital stay. The second type of radiosurgery uses a movable linear accelerator-based machine that is preferred for larger tumors. This treatment is delivered s everaldoses several smallisdoses given over severalradiosurgery. weeks. Radiosurgery that is performed withindivided known as fractionated The total dose of radiation r adiation is higher with a linear accelerator-based mach machine ine than with gamma knife treatment. Another advance in intraoperative radiotherapy (IORT) is the introduction of mobile devices that allow the surgeon to use us e radiotherapy in early-stage disease and to operate in locations where it would be difficult to transport trans port the patient during surgery for radiation treatment. Mobile IORT units have been used successfully as of 2003 in treating early-stage breast cancer and rectal cancer. Radiation sensitizers are another recent innovation in radiation therapy. Sensitizers are medications that are given to make cancer cells easier to kill by radiation than normal calls. Gemcitabine (Gemzar) is one of the drugs most mos t commonly used for this purpose. Preparation Before radiation therapy, the size and location l ocation of the patient's tumor are determined very precisely using magnetic resonance imaging (MRI) and/or computed tomography scans (CT scans). The correct radiation dose, the number of sessions, the interval between sessions, and the method of application are calculated by a radiation oncologist based on the tumor type, its size, and the sensitivity of the nearby tissues. The patient's skin is be marked with a semipermanent ink to help the rradiation adiation technologist achieve correct positioning for each treatment. Molds may be built to hold tissues in exactly the right place each time. Aftercare Many patients experience skin burn, fatigue, nausea, and vomiting after radiation therapy regardless of the where radiation is applied. After treatment, the skin around the site of the treatment may also become sore. Affected skin should be kept clean and can be treated like
CANDO, Precious Gia G. August 17, 2010
NCM-105L AFPMC
Prof. Dawn Capaque
sunburn, with skin lotion or vitamin A and D ointment. Patients should avoid perfume and scented skin products and protect affected areas from fr om the sun. Nausea and vomiting are most likely to occur o ccur when the radiation dose is high or if the abdomen or another part of the digestive tract is irradiated. Sometimes nausea and vomiting occu occurr after radiation to other regions, r egions, but in these cases the symptoms usually disappear within a few hours after treatment. Nausea and vomiting can be treated with antacids, Compazine, Tigan, or Zofran. Fatigue frequently starts after the second s econd week of therapy and may continue until about two weeks after the therapy is finished. Patients may need to limit their activities, take naps, and get extra sleep at night. Patients should see their oncologist (cancer doctor) at least once within the first few weeks after their final radiation treatment. They should also see s ee an oncologist every six to twelve months for the rest of their lives so they can be checked tto o see if the tumor has rreappeared eappeared or spread. Risks Radiation therapy can cause anemia, nausea, vomiting, diarrhea, hair loss, skin burn, sterility, s terility, and rarely death. However, the benefits of radiation therapy almost always exceed the risks. Patients should discuss the risks with their doctor and get a second opinio opinion n about their treatment plan. Normal results The outcome of radiation treatment varies depending on the type, location, and stage of the cancer. For some cancers such as Hodgkin's disease, about 75% of the patients are cured. Prostate cancer also responds r esponds well to radiation therapy. Radiation to painful bony metastases is usually a dramatically effective form of pain control. Other cancers may be less sensitive to the benefits of radiation.
Reference: http://medical-dictionary.thefreedicti http://medical-d ictionary.thefreedictionary.com/Cobal onary.com/Cobalt+therapy t+therapy
CANDO, Precious Gia G. August 17, 2010
NCM-105L AFPMC
Prof. Dawn Capaque
About Radiation Therapy Treatment for Cervical Cancer Cervical cancer is nearly 100 percent curable when identified and treated in the early stages. Radiation therapy is one of the most mo st effective ways to treat cervical cancer in the early stages. Radiation oncologists can administer radiation therapy externally, internally and in combination. Since 1940, with the introduction of the pap test--a routine pelvic exam for women over a certain age and those who exhibit risk factors-- incidents of cervical cancer that result in death has plummeted by 75 percent. Early Diagnosis and Prevention Cervical cancer grows slowly; that's why annual pelvic exams are so effective in detecting it early. Cervical cancer begins with normally healthy cells in the cervix -- the inch-long canal at the lower end of the uterus that connects to the back b ack end of the vagina -- begin to mutate, developing abnormally. While cervical cervical cancer is highly treatable, more than a third of the women diagnosed with the disease each year die from it, with nearly 4,500 cervical cancer deaths per year. Those who succumb to the disease often failed to get preventative screening; many die because the cancer was not discovered dis covered early enough to treat effectively.
Stages of Cervical Cervical Cancer
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Development of cervical cancer Changes to the cervix at the cellular level often present the first indication of cervical cancer. While cellular mutations are not necessarily cancerous, cervical intraepithelia intraepitheliall neoplasia (CIN), or cervical dysplasia, is often detected in women prior to a cervical cancer diagnosis. Noninvasive carcinoma, carcinoma, a very early form of cervical cancer, affects only the outer layer of cervical cells. If left untreated the cancer penetrates deeper into the cervix and the cancer becomes much more difficult to treat. Even the more advanced form of cervical cancer, known as invasive cervical cance cancerr (ICC) is still almost 100 percent curable if caught before it penetrates the cervix too deeply or spreads to other organs. At this stage, cancer has penetrated deep into the cervix and possibly into neighboring tissues and organs. If not diagnosed before befor e it reaches a severe level of penetration and spreads beyond the reproductive tract, invasive cervical cancer kills 95 percent of those afflicted.
CANDO, Precious Gia G. August 17, 2010
NCM-105L AFPMC
Prof. Dawn Capaque
Radiation Therapy for Cervical Cancer The most effective way to eradicate eradicate cervical cancer cancer is to excise the cancerous cancerous cells before they penetrate beyond the lining of the cervix. To do this effectively, radiation therapy is a common form of treatment. When a patient's cervical cervical cancer is more advanced, radiation therapy is often used in combination with chemotherapy. Radiation oncologists administer radiation therapy both internally and externally and sometimes administer both forms simultaneously when treating patients with more advanced cervical cancer Side Effects Radiation treatment itself is not painful; painful; however, however, patients often suffer extensively extensively as a result of the treatment's tr eatment's side effects. Side effects commonly experienced by patients include tiredness, decreased energy, frequent or uncomfortable urination, and loose stool or diarrhea. Patients may also experience skin irritation and lose pubic hair. One of the most sserious erious side effects of radiation therapy in cervical cancer treatment is its potential to prevent the ovaries from functioning, which induces early-onset menopause in younger women. Problems with the vagina are known to arise after radiation treatment. Increased tightness and a lack of flexibility may make sexual encounters and pelvic exams painful or uncomfortable. Many patients are instructed to counteract this tightening effect by using a dilator during the course of treatment.
Reference: http://www.ehow.com/about_50 http://www.ehow .com/about_5079106_r 79106_radiation-thera adiation-therapy-treatment-cer py-treatment-cervical-cancer.html vical-cancer.html
