Radiotherapy

The branch of medicine that deals with the use of radiation for the purpose of treatment is called radiotherapy with us, and the world more and radiation oncology. Radiotherapy is a treatment method that uses penetrating beams of ionizing rays (energy waves or beams of particles-electrons, protons, neutrons) that penetrate the body at a given place and target the desired depth, and localization causing destruction and dying tissue disease. Typically used in the treatment of patients with malignant tumors. The radiation can thus be reduced or completely destroy the tumor node, or reduce the unpleasant phenomena associated with the pressure of the environment of the tumor (pain, swelling and the like.). Many types of cancer can be completely cured by radiotherapy only, such as initial tumors of the vocal cords, localized Hodgkin's disease, ie. Lymphoma and another, which is good to know because it avoids some of the irreversible damage that occurred during surgery (for example. loss of speech in throat surgery). In other radiotherapy may achieve tumor reduction and simultaneous reduction of the extensiveness of the planned surgery. Radiation therapy may be administered in an advanced stage of disease, temporary or palliative treatment - reducing unpleasant or painful phenomena (bone metastases, suffocation due to pressure on the lungs, the bleeding). Radiation can be applied to almost every part of the human body, can be used before, during or after surgery, or chemotherapy. 

Radioactive radiation that is used to treat, unlike the one in the diagnosis, occurs in two ways: from devices that produce X-rays, but much higher energy than that used in the diagnosis, or from natural sources of radiation - radioactive elements. 

Equipment used in radiotherapy include its complexity and value of the most expensive devices in medicine. Therefore, such therapy is applied only in specialized centers with appropriate equipment, protective equipment and where to specially trained team of people. 

A device that is used in radiotherapy are the most common linear accelerator and cobalt bomb. There are other devices that are used rarely and only in research centers, such as the proton and neutron bombs, and the like. Cobalt-bomb is a device that uses a natural source of radiation, radioactive cobalt. It is interesting to know that the cobalt source is that small, that the capsule size of about 1 up to 2 cm 2, which is located within a separate protective container. Within the complex mechanisms of the head device in which the capsule is located there is formed with the size and shape can be controlled, and that way during the session transmits the radiation beam. Activity of cobalt is very large, so that in time of approximately one minute, at a distance of 80 cm from the source generally obtained by standard daily dose. The radioactivity of cobalt decreases over time (radioactive elements break down over time) and 5.26 years of decline to half of the initial value. Therefore, the source should be renewed every 6-7 years. In addition, the source used is a continuous source of radiation, and as such requires extra caution when handling and maintenance of equipment, and the subsequent disposal in special institutions. 

The linear accelerator is a modern device that today in most institutions are increasingly replaced by cobalt bomb. It does not use natural permanent source of radioactivity, but the radiation produced in the device, and only when the device is in operation. There are two forms produced by radiation - photon and electron radiation. Energy of such radiation are high. Photon beam is used for tumors located deeper in the body, and electron irradiation is used for superficial tumors located. 

There are two types of radiation therapy - inside and out. Devices that are used in radiotherapy (linear accelerator, cobalt bomb) are used for radiotherapy, which is also called teleradioterapija. In teleradioterapiji is, from the device in which radiation occurs, the beam of invisible air drawn from outside the body through the skin, in depth, the tumor and some surrounding tissue. The choice of device depends on the equipment and capabilities of the center that applies the therapy and the localization, ie the depth at which the tumor is located in the body. Most people are treated in this way, and this type of therapy may be performed hospital and ambulatory. 

Another type of treatment brachytherapy - radiation or near most commonly, internal radiation. In this method using radioactive sources that are made in the form of needles, tubes or wires, or granules or liquids. Being in nature, the amount of radioactive elements small and collecting the required amount is almost impossible, they are produced in nuclear reactors, according to the needs of the customer. Inactive elements, exposure to nuclear reactions in the reactor are converted into their radioactive isotopes. That made ​​radiation sources are placed in brachytherapy in body cavities or directly into the tumor ("implanted"). Such therapy is performed only when the patient is in the hospital. Typically used in the treatment of cancer of the uterus, vagina, prostate, esophagus sometimes, nasal cavity. 

In radiotherapy used high doses of radiation to destroy tumor tissue. The risk of destruction and the healthy tissue around the tumor is always present and real. Expected effectiveness of radiation therapy must therefore be greater than the risk of damage to radiation chosen as the treatment of choice. Improper or incorrectly applied radiation can be life-threatening, especially for a person to be treated, but also for the staff who work with radiation sources. It is therefore necessary that such therapy planning and execution of specially trained doctors-specialists in radiotherapy, together with colleagues who are also specially trained to work with radiation and who know the good and bad sides of radiation. 

Sideefects may or may not appear. Many patients have almost no complaints, especially if you abide by the instructions. Most often perform two or three weeks of the start of radiation and disappear in a week or two after the completion of radiation - fatigue and exhaustion, loss of appetite, loss of a few pounds in weight. During radiation is controlled by blood, and sometimes can be observed decrease in the number of blood cells, usually leukocytes, which is after the end of irradiation is usually normal. Sometimes with diet and hygiene measures need medication to calm things down problems. If the side effects are particularly severe, sometimes be interrupted for a short time irradiation to lead to recovery. When pelvic radiation most common side effects are diarrhea and urinary disorders (frequent urination, burning or pain). It is therefore advisable during radiation adhere to the prescribed diet, and drink ample fluids, it is often only those procedures can avoid side effects. 

Radiation to the head and neck 

The most common side effects that can be expected: dryness or excessive occurrence of saliva in the mouth, burning in the mouth or on the skin of the door, the occurrence of fungal plaque in the oral mucosa, difficult and painful swallowing. 

When radiation scalp hair tends to fall, on which the patient's doctor - radiotherapist notified before the start of treatment. It is important to note here that the hair falls only if the scalp in the area (volume) of radiation. The decline is permanent hair more often because it is caused by the destruction of the hair roots. Sometimes hair to grow back, but the eventual possibility of re-growth of hair is not expected immediately after treatment (such as in hair fall during chemotherapy). 

The most common side effects that can be expected: the passage of food through the esophagus occurs, at the end of radiation lung and esophagus, often a sensation of burning, pinning bites, pain behind the breastbone. If the radiated breast after conservative surgery can occur swelling of all or part of the breast, pressure or painful skin irritations and especially those nipples. Leather axillary area and under the breast may be red, become soft, moist and vulnerable and furnaces. 

The most common side effects that can be expected: loss of appetite, nausea, sometimes vomiting. We will try to suppress them by taking small portions of food; Sometimes the annual dry food. After several weeks of radiation may occur more frequently stools (or diarrhea), and if it radiates part below the navel, sometimes occur and burning and pain when urinating. 

During therapy often present lack of interest in sex life, and even discomfort and pain during intercourse. As a result of radiation genitalia occurs subsequent sterility in men (mostly permanent character), and in women cessation of menstruation and early menopause. Damage to the reproductive cells are inevitable, so that during and after radiation therapy is not recommended to stay pregnant or have children. 

The skin in the treated area on both sides of the body becomes red, irritated and dry. Later, especially in the folds can occur and moist reaction. It is important not to expose the skin to additional stimuli. Skin radiated areas follows a clean lukewarm water, do not use soap and do not rub the skin, and delete only gently with a soft towel. Do not wear synthetic fabrics than just pure cotton, and not too tight clothing. Not applied on the skin either hot or ice packs, creams or lotions, except neutral (Bepanthen cream, cream or Wolf basis Belobaza). It is important for two hours before and after irradiation nothing to put on the skin during radiation skin should be clean. 

Nutrition 

To avoid diarrhea, avoid wholemeal bread with seeds, fat, cabbage, beans, raw fruits and vegetables, sweets and milk, cream, coffee and strong spices. Food should be varied and nutritious meals. You need to eat more frequent smaller meals, cooked lean meat, fish, cooked vegetables, potatoes, rice, pasta, white bread, sticks, syrup, bananas, cottage cheese, yogurt, etc.. If he had diarrhea, the best liquid diet (low fat soups, tea) and toast. After completion of radiation should follow a diet food for another week or two and then gradually move on to a normal diet. To avoid irritation of the bladder, one should drink plenty of fluids, preferably tea and non-carbonated mineral water. Coffee avoided. 

Late effects of radiation 

Radiation changes the target tissue, and the tissue through which it passes, especially if the tissues more sensitive to radiation. Such changes in most of the tissue does not happen immediately, but over a certain time, which can be several months, even up to several years, and is called late reactions to radiation. Careful planning, new techniques and highly sophisticated devices for therapy, with knowledge of the sensitivity of different tissues, the consequences of this kind are increasingly rare, but it is impossible to suppress completely. 

X rays and gamma-rays may cause cancer and other diseases and damage, but it often happens in people who were exposed to them for a long time. Therefore, people who work with radiation specially trained to recognize potential risks and apply the prescribed protective equipment, and are required to conduct regular and annual preventive examinations. The risk of second cancers in patients who were treated with radiation also exist, but generally such cases are described when the first rays either in childhood or early adulthood.