Questions and Answers

Most common questions were collected by the reception desk of the oncology outpatient clinic. Complete with answers, they constitute a vital information base on what cancer treatment is. How to treat a neoplasm? Is irradiation the same as radiation therapy? How to diagnose cancer? Is cancer a sentence?, etc.

Radiation therapy

What is radiation therapy, what does it consist in?

Apart from surgery and chemotherapy, radiation therapy is one of the main forms of oncology therapy. It involves the irradiation of a neoplastic tumour (or an area where is was situated prior to surgical procedure) by means of a beam of ionizing radiation. Adequately high radiation doses may destroy neoplastic cells or inhibit their further growth and division. The most common to be applied is external radiation therapy (teleradiotherapy) – in this case radiation beams are generated in devices dubbed medical accelerators.

Radiation therapy may be administered as a monotherapy, in conjunction with chemotherapy as well as following surgical procedures and chemotherapy.

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What document should the patient bring to the first appointment?

Histopathological examination results
Hospital discharge summaries from other hospitals such as following a surgical procedure, chemotherapy
Imaging examination results: MRI, CT, X-ray
List of medicines administered

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Is radiation therapy effective in the fight against cancer?

Radiation therapy is one of the most effective methods in the fight against cancer. It relies on ionizing radiation for destroying as many neoplastic cells as possible. Half of all patients suffering from a neoplasm undergo radiation and the number of patients cured by this method increases on an annual basis..

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How does the first appointment at the Center for Radiation Therapy look like?

To the first appointment with a physician the patient must bring a personal ID card and complete medical documentation covering treatment heretofore. Medical documentation also refers to CD discs with the recordings of computer examinations: magnetic resonance imaging (MRI), computer tomography (CT), X-ray and PET-CT scan.

The reception desk staff contact the patient one day prior to the scheduled appointment in order to remind of it as well as to confirm it.

The duration of the first appointment with a physician is approximately 30 minutes. Subsequently, the patient is referred for a computer tomography scan (that takes approximately 30 minutes) and if the treatment requires that a special immobilization be prepared – the patient is referred to a modelling facility.

At the next stage, the results of both the patient’s interview conducted by the physician and the computer tomography scan are subjected to the so-called planning, at which point medical physicists and physicians determine the patient’s treatment schedule. Since this process is complex and the medical personnel aims to develop an accurate and premeditated treatment schedule – it may take up to 2 weeks.

Upon establishing a treatment schedule, the patient is notified by phone of the date of the commencement of irradiation at the Center.

Once the patient comes to the Center for the commencement of the treatment, he or she is shown the way to the waiting room, from where medical technicians ask him or her for the first irradiation session in the presence of the lead physician. In the intervals between consecutive appointments, depending on their frequency, follow-up visits are set up for the lead physician to examine the condition of the patient and for the patient to share his/her doubts with the physician.

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Why are tattoos made?

Tattoos are fixed marks on the patient’s body that enable repeatable and precise patient positioning on the therapeutic table. During shorter (e.g. 5 fractions) radiation cycles it is possible to apply transient/removable markings but with longer cycles durable markings are required.

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Who takes care of the patent during treatment?

A team of qualified specialists look after the patient during radiation therapy. The team comprises: lead physician – oncology radiation therapist, medical physicist, radiation therapy technician, electronics engineer and a nurse

Physicians – oncology radiation therapists – decide what treatment type and strategy to employ, what the dose of radiation, areas to be treated will be and limit the amount of healthy tissue to undergo irradiation so as for the radiation to mainly affect neoplastic cells.

The physician and the nurse take care after the patient throughout the therapy. The medical physicist determines the therapeutic technique and elaborates an individual therapeutic schedule. Radiation therapy technician conducts daily irradiation sessions and electronics engineer ensures safe operation of all the devices.

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How long does it take for the treatment to start?

Following the validation of eligibility for radiation therapy and the performance of the so-called preparation procedures (computer tomography, magnetic resonance imaging, PET examination), radiation schedule development takes about 1-2 weeks.

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How long does the treatment an radiation itself take?

A single radiation therapy session lasts about 10 minutes, the entire treatment may span from 1 up to 7 weeks, depending on the treatment objective, dosing method and the patient’s tolerance of the therapy. In some clinical circumstances, the patient undergoes a single radiation session.

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Will I be able to work during treatment?

Some people may be able to work, others may work part-time, others still may go on a sick leave. However, when fatigue, energy drop and malaise kick in, it’s time to talk to the physician of further steps.

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Does radiation therapy hurt?

No. This procedure is painless. Various ailments, including pain, can exacerbate over the course of treatment when the symptoms of the so-called acute post-irradiation reaction appear – a local reaction of healthy tissue within the area under irradiation.

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Whom to contact should ailments occur?

During treatment patients attend regular appointments with the lead physician who shall provide information how to alleviate any ailments associated with acute post-irradiation reaction. All disturbing symptoms should be reported to the physician during an appointment. Should a need arise, contact with a physician may be promptly sought for at the reception desk . No ointments, rinses or herbals should be applied of one’s own accord without consultation with a physician. A radiation therapist determines the number of irradiation cycles or the tumour area as well as the dosage. Usually, radiation therapy is administered for 5 days a week. Depending on the physician’s guidelines, it may be shorter or longer as the overall radiation dose as well as the number of procedures is conditional upon the type and advancement of neoplasm, patient’s general health and other concurrent forms of therapy.

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When to commence radiation therapy following a surgical procedure?

If there are indications for post-operative radiation therapy, treatment may be started after the post-operative wounds are completely healed. Upon the completion of convalescence.

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Is a pacemaker a counterindication against radiation therapy?

Pacemaker is not a counterindication. However, it is vital to consult the cardiology center where the pacemaker was implanted.

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Can a patient subject to irradiation pose a threat to his or her family? Is it allowed to be near children?

Patients subjected to teleradiotherapy and brachytherapy do not emit radiation upon leaving the therapeutic room so they pose no threat for persons in their surroundings, including children.

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Is the treatment applied exclusively in hospital settings?

In most cases the patient is treated in an outpatient mode, i.e., he or she remains at home or at a hostel and once a day receives a fraction of therapy. He or she may attend radiation therapy centre on his or her own or by means of organised transportation. Therapy may also be delivered at radiation therapy ward – it is up to the physician to determine the mode of treatment.

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How much time must elapse following radiation therapy before a computer tomography (CT) and magnetic resonance imaging (MI) may be performed after completed treatment?

In principle, there is no need for a diagnostic examination earlier than 3 months after completed treatment. The lead physician decides whether the examination may be taken.

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What does the term “tomography” mean in the context of treatment planning?

This is examination by means of computer tomography – a procedure required for the preparation of irradiation planning. By definition, the examination does not serve to diagnose the patient.

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What should a patient take for a stay at ta hospital ward?

The patient should come to the ward equipped with: slippers, a change of pyjamas, personal care items, medicines in original packagings.

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Magnetic resonance imaging

What is an MRI examination?

It is an examination method based on the phenomenon of nuclear magnetic resonance. The patient is placed within a potent magnetic field and, in addition, exposed to radio waves. As a result of complex processes ongoing inside the organism that are processed by the computer system throughout the examination, an image of the examined organ is formed in any desired plane and also in three dimensions.

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How to prepare for an MRI exam?

The examination does not require any special preparation. However, since it might be necessary to administer contrast medium during the examination, it is recommended for the patient not to eat meals 2 hours prior to the examination. Due to a strong magnetic field within the facility wherein the examination is conducted it is recommended that the patient not wear metal parts (buttons, zip-fasteners, sequins).

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How long does a magnetic resonance imaging examination take?

The examination takes about 25 minutes. Should contrast medium need to be applied, the duration extends to 45 minutes.

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Is the noise accompanying magnetic resonance imaging dangerous?

The noise accompanying MRI does not present any danger. In order to mitigate the discomfort, the patient receives earplugs.

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Is referral required for a paid MRI examination?

No, no referral is needed for a paid MRI examination. Upon arrival, the patient fills in a referral and a questionnaire concerning counterindications for undergoing the examination.

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Is referral required for a paid MRI examination?

No, no referral is needed for a paid MRI examination. Upon arrival, the patient fills in a referral and a questionnaire concerning counterindications for undergoing the examination.

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Is MRI examination safe?

MRI examination is considered very safe. The examination utilizes magnetic field and radio waves which do not cause any side effects.

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What is a contrast medium?

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How is a contrast medium administered?

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Computer tomography

What is a computer tomography examination?

It is an examination method, allowing to obtain images (sections) of a body area under study by means of X-rays. Throughout the examination, the X-ray tube, unlike in traditional X-ray examination, rotates around the patient’s long-axis. The radiation beam is attenuated following the passage through the patient’s body. The attenuation rate is recorded by a set of detectors. The values are recorded and processed by a computer system that conjures the image of a body area under study.

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How to prepare for a CT examination?

The patient should come along with an accompanying person. Prior to the examination, the patient should remove all metal elements from the area under study such as zippers, buttons, belt buckles, safety pins, etc., as well as undo all hair accessories, take off jewellery, glasses, hearing aids, dentures.

Since contrast media are frequently administrated in computer tomography for image improvement either intravenously and/or orally, no meal should be consumed 4 hours prior to the examination.

A patient with a scheduled examination with the use of a contrast medium should be well hydrated. Hence, it is recommended for the patient to drink 1 litre of still water over the period of 6 hours leading up to the examination.

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How long does a computer scan examination take?

The examination takes from 3 to 15 minutes, throughout which the instructions of the personnel should be closely listened to.

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Is a referral required for a fully paid examination?

Yes, a referral from a physician is required to undergo a fully paid CT scan.

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What is a contrast medium?

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How is a contrast medium administered?

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Is CT examination safe?

Yes, it is safe and has been applied for many years.

X-radiation are used in a CT scan. The doses to which the patient is exposed during the examination are safe. Due to the application of X-radiation, the performance of such examinations is limited in children and adolescents.

Moreover, radiological shields are commonly used to reduce radiation wherever necessary.

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Miscellaneous questions

What is a contrast medium?

An opaque medium, a so-called contrast medium, is a liquid substance employed in diagnostic tests for enhancing image resolution. Contrast medium boosts the quality of the examination performed.

It is used frequently but not in all circumstances. If it is used during your examination, then it must have been prescribed by the physician. This is a standard part of imaging and should not cause concerns.

An opaque medium is more likely to be applied in computer tomography scanning than in magnetic resonance imaging.

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How is a contrast medium administered?

A contrast medium is administered intravenously and/or orally.

Intravenously by peripheral venous catheter inserted on the patient’s forearm by means of automatic syringe or by manual injection.

In some cases a sensation of cold may occur at the injection site. This s a normal reaction that recedes quickly.

In most cases of CT scans of the abdominal cavity and pelvis minor, contrast medium in the form of aqueous solution is also administered orally. The patient receives an aqueous solution, prepared by the nurse, an hour prior to the examination. The contrast medium should be swallowed slowly and in small sips, in accordance with the instructions given by the nurse.

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