Cancer Patients

welcome to the princess margaret cancer centre. this video is an introductionto radiation therapy treatment to the head and neck area. we hope to give you a better ideaof what it will be like to have radiation treatment and explain some of the ways we can work together to help youget through your treatment successfully. in the most general sense,radiation is any sort of energy such as light, heat, or sound. ionizing radiation is a typeof radiation that can damage cells,

such as ultraviolet light from the sunthat can damage your skin, causing sunburns. for radiation therapy treatment we use a high-energy beam of radiation that can penetrate through the bodyand treat tissues under the skin. ionizing radiation affects all of the tissues it passes through, but there are 3 main ways that it specifically targets cancer cells. first, cancer cells are more sensitive to radiation damage than healthy cells. secondly, cancer cells are less able than healthy cells to repair the radiation damage.

third, we can focus the radiation beams on the area we want to treat. in the next part of the video,we will show and describe some of the procedures you will have done to prepare for radiation treatment. one of your first appointments in this department is called ct simulation. this is a type of ct scan that is needed to create your personal treatment plan. at this appointment, you will also have a molded mask made that fits over your head and shoulders. the mask will help make your treatments as quick and accurate as possible. it is normal to feel a bit anxious about this procedure.

it may help to know that the mask does not hurt you and you will be able to breathe normally the entire time. the mask is a type of plastic that we soak in a warm water bath to make it soft. then we shape it over your face, neck and shoulders, and clip it onto the treatment bed. you can see here how the mask looks when it is flat. and then after it has been shaped to fit your head and neck. this is what it looks like when the mask is made. it goes over your face quickly and we help shape it

around your nose, neck, and shoulders. you’ll have your eyes and mouth closed for this step, only because there is a bit of water still on the mask. the mask is meant to be snug but should not hurt. you will be able to breathethrough the holes in the mask. for your treatment appointments, there will be holes in the mask in the area of your eyes, mouth and neck, so it should be a little bit more comfortable. once the mask is ready, we draw some marks on it and take the ct scan.

at the very end, we may talk to you about making a permanent, freckle-sized tattoo on your chest. the marks on the mask and the tattoo help make your treatment every day as quick and accurate as possible. there are a few other things you need to know about this appointment. first, you may have a dye injected into your arm for the scan. if this is the case, we will explain this part of the procedure to you at your appointment. secondly, you may also have a small device made for you

to help keep your mouth open. again, we will explain this at your appointment if this step is necessary. once all the marks are on the mask,and everything has been verified, the therapists will leave the room to start the scan. [therapist speaking into microphone] the therapists can see and hear everything from where they are sitting in the control room. the scan is completed and the images that are acquired are reviewed by the therapists and sent to the doctors

so that the planning process can begin. we will now talk about some of the other appointments you may have around the same time as your mask and ct scan. your radiation oncologist is the doctor in charge of your radiation treatments. he or she will meet with you to explain what the treatment is all about, and answer your questions. you may also have other appointments with a cancer surgeon or chemotherapy oncologist to make decisions about your care. you may have blood tests, hearing tests, x-rays, mris, or other scans.

these appointments help us make decisions with you about your care. one important appointment is with our dentistry department. most patients will see the dentist before they begin treatment. because radiation treatment to the mouth area may affect your saliva, tongue, gums, lining of your mouth, and throat our dentists see if you would need any dental work done before treatment and give you instructions on caring for your mouth. we will give you more information about caring for your mouth later in this video.

the next few images will describe how all of your radiation appointments fit together. you have just seen what it will be like to have a ct scan and mask made. around this time you may have other appointments that help your medical team make decisions about what the best treatment is for you. once all the information needed to prepare your treatment is ready, your radiation oncologist can start preparing your radiation treatment prescription. this normally takes about one week after you’ve had your mask and ct scan. you will then receive a phone call with the date and time

for your first radiation treatment. your first treatment will usually be approximately one week after this phone call. during the second week, we will be creating your customized treatment plan and testing it to make sure everything is correct. behind the scenes this work involves your radiation oncologist, a radiation therapist treatment planner, and a radiation physics staff. this is a good time to finalize any plans you may need to make for home, work, and travelling each day for your appointments. let us know if you need any help, or if you have any questions

so we can provide more information or make referrals as needed. for example, many patients are helped by our social worker with questions about financial assistance programs, medication coverage, or hospital and community resources. once treatment has started, you will come in for treatment every weekday, monday to friday.you will have a break for some holidays, but we do wish to avoid extra long weekends or unnecessary breaks in your treatment. most patients will be treated once each day, but some patients will have both a morning and afternoon appointment.

the total length of the treatment course is usually between 5 and 7 weeks. when all radiation treatments are completed, you will have a follow-up with your radiation oncologist. just to summarize, you might hear these stages referred to as “pre-treatment”, “planning” “treatment”, and “follow-up”. the next part of the video will show you what it will be like

during your treatment appointments. these appointments will be on level 2b. the staff at the reception desk will help you find your way. your entire appointment is about 15 minutes from start to finish. each day you will need to remove clothing and jewellery, just as you did for your mask and ct scan. your radiation therapistswill ask you to lie on the bed and will fit your mask as they get you in the right position. although it isn’t shown here for this patient, remember that your mask

will be cut out for your eyes, mouth, and possibly your neck as well. the bed moves up and under the machine, and you may see and hear the equipment moving around you. the machine does not touch you at any time. the therapist will leave the room before delivering your treatment, but can see and hear you from outside using a video camera and an intercom. let us know if you are uncomfortable by waving your hand or making a sound. many patients listen to music in the room during the treatment to help pass the time.

from outside the room, the therapists will take some images to check your position. based on these images, they will make any adjustments that are needed to make your treatment as accurate as possible. when the treatment begins, you will see the machine move around you and hear it make several different sounds. it is normal to be anxious about what it feels like when the radiation treatment is being delivered. some new patients are concerned that they will feel the radiation burn them, but this is not the case.

you won’t actually feel the radiation when it is being delivered, and you won’t experience any side effects right at this moment. the side effects of radiation actually take a week or two to begin, and then progress gradually. we will talk about these side effects next. you will not have side effects of treatment right away. these take time to develop, typically about 2 weeks. this means that your first side effects are likely to start in the second week of treatment, and reach their peak after your entire course of treatment is done.

the extent of your side effects will depend on where your treatment is, so please rely on your medical team to describe the expectations of your specific treatment. if you are having treatment just to your voice box or thyroid, most of the side effects we are about to describe will be mild or will not apply to you at all. if you are having treatment focused on the back of your mouth, most or all of these side effects will apply to you. if you are having treatment to other areas, such as your lips or sinuses,

there may be other side effects and care instructions that we do not cover in this video. again, your medical team will help identify what the expected side effects are for your specific situation. you may also have a reaction on the inside of your mouth. this may be on your tongue, gums, or the lining of your mouth. as with other side effects of treatment, the exact location and severity will depend on your treatment plan. we recommend that you use baking soda mouth rinse

or flat club soda several times a day to keep your mouth clean and soothe the irritated tissue. you may use a soft toothbrush or swab to clean gently inside your mouth. do not use over-the-counter or previously prescribed mouthwashes as these can be harsh on your mouth. let us know how you are managing with these side effects as we can prescribe a soothing mouthwash and pain medications as needed. it will help to avoid smoking and drinking alcohol as these will irritate your throat.

quitting smoking may reduce your side effects, improve your treatment outcomes, reduce your chances of getting another cancer in the future, and improve your overall health. quitting can be a difficult but very beneficial life change. your medical team can help if this is something you want to do. you may find that certain food and drink will irritate your mouth or throat, such as acidic or spicy foods. if so, you may wish to avoid these during treatment. the treatment may also make your mouth feel dry

and your saliva thicker. swallowing thick saliva can make your stomach upset, which it may already be because of taste changes, medications, and other factors. this is best managed by carrying a bottle of liquid to sip on throughout the day and doing regular baking soda rinses to clear out the thick saliva and soothe your mouth. along with these changes, you may find changes in your sense of taste and a reduced appetite.

we also recommend a humidifier in your home, particularly by your bed, to keep the air moist and soothe your mouth and throat. as the changes in your mouth and throat progress, your medical team may offer other mouth rinses and medications to help you manage. you will now see some images of what the changes inside your mouth may look like. this may be difficult to look at, but may also help you be more prepared. also remember that depending on your specific treatment plan,

the side effects you are about to see may not apply to you. notice that the changes happen slowly, but they do progress throughout treatment and for a while after all the treatments are done. in these images, you will notice a clear plastic apparatus in the mouth. this is strictly to help keep this patient’s mouth open for these pictures only. this will not be part of your treatment. this first image shows how the patient’s mouth looks like at the beginning of treatment.

although it isn’t too clear at this point, the treatment we will use will focus more on the left side of this patient’s mouth. this next image is a couple of weeks into treatment. at this point, there is more than likely a change in taste, as well as a noticeable amount of dryness in the mouth. all this can be helped to some extent with regular mouth rinsing and drinking more water. these next pictures show this patient’s mouth nearing the end of treatment. there is a lot of irritation on the tongue on the left side.

the mouth can be sore at this point and make it hard to eat. again, regular drinking of water and mouth rinses can help these side effects, as well as possible medications which are prescribed by your oncologist. this last image is a couple of weeks after treatment. you will notice that the roof and the back of the mouth have healed quite well, and that there is just an area on the tongue that is in the process of healing. this patient’s mouth will continue to heal in the weeks to come. remember that although this may be a difficult part of treatment, we are here to help you manage these side effects.

depending on your specific situation, your eating and drinking may already be affected. changes in your mouth and throat from treatment can also affect your eating and drinking. maintaining your weight and nutrition will be a high priority. your body needs nutrients to heal and recover from the treatment, so now’s not the time to try and lose weight even if you feel you may have some weight to lose. it may help to switch to softer foods such as mash or pureed foods if needed.

and consider whether the food you are eating has enough calories and protein to help your body stay healthy. you may also use meal replacement drinks to supplement your diet. more information about changes to your diet are available in pamphlets and from your healthcare team. depending on your needs, you may have regular appointments with our dietitian or we can arrange for you to see one of our dietitians as needed. you may have a feeding tube already, or we may recommend that you have one insertedearly on in your treatment

as a temporary way to help you with nutrition and hydration during treatment. your oncologist will describe this more in detail if a feeding tubewill be part of your care. your skin is also affected by the radiation treatment. ensuring that your hands are clean, you can apply skin cream in the treatment area. we recommend that you keep your skin hydrated by applying an unscented moisturizing cream several times a day on the outside of your neck, chin, throat, and across your upper shoulders.

your medical team will give you more instructions as your skin reaction progresses. these next pictures show how the skin gradually changes with treatment. these first images show how this patient’s skin looks before the start of treatment. approximately two weeks into treatment, you can see that this patient’s neck has developed some redness which is caused by the radiation. the skin at this point may feel a little tender and sensitive. about halfway through treatment, you can now see how the skin

in the neck area is visibly more red, with some dry patches. at this time, the skin can feel very sensitive and will be itchy. with proper care and advice from your medical team, these side effects can be managed. this is nearing the end of treatment for this patient. remember that any skin reactions you experience can be worse or even better than this patient’s images show. these last images show when the patient has come back for his follow-up appointment. although there is some slight pigment change in the skin, which is possible,

the side effects have subsided with continued management and care. remember that although this maybe a difficult part of treatment, fatigue is a common side effect of treatment as your body is healing each day. fatigue may also result from disruptions in your regular routine, especially changes in your eating and drinking. we recommend that you try to follow regular sleeping habits and rest if you need to through the day. maintaining your food and water intake and keeping active should also help. finally, changes to your tongue and throat may affect your voice

and your ability to swallow. exercising your tongue and other muscles involved in swallowing is an important way for you to help reduce this possible side effect. later on in this video, you will learn about a number of exercises you can do to help. now that we have described the main side effects of radiation, we will talk about some of the ways we can help you get through treatment. during your course of treatment, you will see your radiation oncologist regularly to monitor how you are doing and help you manage any side effects.

while you wait you may be asked to fill out a survey to help us understand how you are feeling and how we can best help you with care. these questions can be done while you are waiting to see the doctor, and take about five minutes to complete. staff in the waiting room will show you how to do this. the radiation therapists that deliver your treatment every day can also help you with advice or referrals to other services. you can always be seen by a nurse or a doctor in the radiation nursing clinic, behind the main reception desk on level 2b.

you will also have appointments with other medical specialists during your treatment as needed. this may include dentists, nurses, dietitians, social workers and pharmacists. let us know what your concerns are, and we will help you contact the right people. if you want more information, in addition to your medical team two great resources are the princess margaret cancer centre library, located on the main floor of princess margaret, and the ellicsr survivorship centre, located at toronto general hospital. feel free to drop in and have a look around. before we finish, there are a few common questions

about appointments and transportation that we would like to cover. your treatment appointments are booked by our patient flow coordinators, who can be contacted using the numbers on the green card you will receive at your ct scan. you can call these numbers if you have any questions or concerns about your appointments prior to starting treatment. once you start treatment, you will be given an appointment schedule every wednesday, with all of your appointments for the following week.

at this time, talk to the radiation therapists on your treatment unit if you have any schedule concerns. many of our patients live far enough away that travelling in to the hospital every day for treatment is a concern. there are two options that may help with this. first, the canadian cancer society can provide volunteer drivers to bring you to and from the hospital. second, patients from out of town can arrange to stay monday through friday at the princess margaret lodge,

and return home on weekends. more information about either one of these options is available at the reception desk on level 1b or the patient & family library on the main floor. you have now seen and heard a bit about what it will be like to have radiation therapy. if you have any questions about anything in this video, please feel free to discuss them with any member of your medical team. we are here to help.