External Beam Radiation Therapy: Understanding Your Treatment and Care

You may be feeling worried about starting radiation therapy. But understanding how it works can make the experience more manageable. This guide offers an overview of what you can expect as you go through treatment.

What is external beam radiation therapy?

Radiation therapy is a treatment for cancer. It uses targeted high-energy X-rays or particles to destroy cancer cells. It can help stop cancer from growing and spreading in the body. There are several types of radiation therapy. The type most commonly used to treat cancer is called external beam radiation therapy. A machine aims the rays or particles at the tumor from outside the body. There are many different types of external beam radiation therapy. Ask your healthcare team about your specific type.

Your first appointment

The first step of treatment is an appointment with a radiation oncologist. This healthcare provider specializes in treating cancer with radiation. During this visit, you can expect:

• A review of your health. The provider asks about your cancer and medical history.

• A discussion of treatment options. The provider talks through your options. You then decide if radiation therapy is right for you.

• A chance for questions. Ask about side effects, timelines, treatment schedule, limitations on your activity, or any other questions you have. You can also share your worries and concerns.

Planning for treatment

Before you start radiation therapy, you’ll have a planning appointment called simulation. This helps determine the exact position you’ll be in for all your radiation treatment. You will work with a radiation therapist who helps give the treatments. During the simulation, you can expect:

• Positioning. The radiation therapist helps you find a comfortable position.

• Stabilizer devices. These tools help you stay still. They ensure the treatment is targeting the right spot.

• Imaging. The therapist uses a CT or MRI scan to show the cancer’s location and best treatment angles.

• Markings. The therapist makes marks about the size of freckles on your skin. Usually they make 1 to 5 marks. These may be permanent, like tattoos. Or they may be temporary marks. But they aren’t very visible. They serve as guides during your treatment.

What to expect during treatment

Once your plan is ready, your radiation therapy can begin. Most people have daily sessions for a few weeks. Ask your healthcare team about your exact schedule. During each session, you can expect:

• Positioning. You may need to wear a medical gown depending on the area being treated. You lie down on a table. The radiation therapist positions you. Stabilizing devices or molds may be used. They might use special shields to protect other parts of your body not being treated.

• Radiation delivery. The radiation machine moves around you but doesn’t touch you. It delivers radiation. It doesn’t hurt. The machine may be noisy. You will be able to talk to the therapist through an intercom during treatment.

• Duration. Each session lasts about 15 to 30 minutes. The actual radiation takes only a few minutes. In most cases, you will go home after treatment. You are not radioactive during or after treatment because there is no radiation source inside your body.

Side effects and how to deal with them

Radiation therapy can cause side effects. These can differ from person to person. Side effects depend on which area of your body is being treated. For example, side effects will be different if you have radiation therapy to your brain versus to your abdomen. Side effects also depend on the dose, the length of treatment, your general health, and the specific type of radiation therapy.

Early side effects start during or just after treatment. They usually go away a few weeks or months after treatment ends. Late side effects may show up months or years after treatment ends. Ask your provider what short- and long-term side effects you can expect and how to manage or prevent them.

Common side effects are:

• Fatigue. You might feel tired. Rest and sleep may help.

• Skin changes. The skin near the treatment area may become red, itchy, dry, or blistered. Use gentle soaps and lotions as directed by your healthcare team. Avoid direct sunlight.

• Hair loss. Radiation may cause hair loss in the treatment area. For example, if you have radiation to your head, you may lose the head on your hair. If you have radiation to your pelvic area, you may lose your pubic hair. Your hair may grow back after treatment ends, but it may be a different texture or thickness. Or your hair loss may be permanent.

• Loss of appetite. It can help to eat small, frequent meals.

Radiation can affect your ability to have children depending on the location of treatment. If you want to have children in the future, talk to your healthcare team about the effects of radiation on your fertility before starting treatment. They can direct you to fertility specialists and other resources as needed.

Ask your healthcare team what side effects to watch for and when to report them. Ask how to contact your healthcare team after office hours, and on weekends and holidays.

When to call your healthcare providers

It's important to be open and honest with your healthcare team. You should call your healthcare providers if you:

• Have a lot of pain

• Notice side effects getting worse

• See signs of infection, like swelling, redness, or pain

• Have trouble breathing

Tips for coping with treatment

Radiation therapy can be hard mentally and emotionally. Here are some tips that may help you cope:

• Share your feelings. Talking with friends, family, or a counselor may help you feel better.

• Try to relax. Deep breathing, meditation, yoga, or even sitting quietly by yourself can help.

• Stay active, if you can. Walking or other light activities may boost your mood and energy. Ask your healthcare team what activities are safe for you.

Finding help and support

There is help available beyond your provider’s office. Ask your healthcare team about support groups or talking with a social worker. There may be additional support people on staff, such as counselors and financial advocates. You can also search for resources online. Reach out to friends and family who know what you’re going through. Connecting with others who have had radiation therapy may help you feel better. You can also learn from their experiences.

Post-treatment care and follow-up

Cancer care doesn’t end when radiation therapy is complete. In the next phase, you can expect:

• Follow-up appointments. Your healthcare provider schedules regular checkups.

• Continued communication. Stay in touch with healthcare providers.

• Long-term self-care. Find activities and routines that make you feel good.

Celebrating small victories

As you go through treatment, mark your successes. Celebrate wins, big and small, like:

• Completing each treatment session. Note your progress on a calendar.

• Feeling better. Notice when side effects lessen or you have more energy.

• Reaching important moments. Celebrate the end of a week or finishing your treatment plan.