You Said Oncologists Dont Always Follow Guidelines Why Not
Clinicians may not always follow the guidelines because they know the patient best. ThatÃ¢s why theyÃ¢re not requirements. However, often clinicians may be too busy to keep up or they may not be up to date or as familiar with recent changes in supportive care when rapidly changing, complex therapeutic decisions occupy their minds.
The guidelines get updated every year or two with new evidence and new data. The growth in the field and the expansion of knowledge has been more rapid in recent years. There are new agents and new studies to show who should get these agents and who shouldnÃ¢t. Keeping up with all of this, on top of their primary concern Ã¢ the cancer itself Ã¢ is a lot.
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Causes And Risk Factors
Radiation therapy works by damaging DNA in cells. This damage isn’t isolated to cancer cells, though normal cells can be damaged as well. While radiation therapy has improved significantly such that less damage occurs to healthy cells than in the past, some healthy tissues are inevitably exposed.
Several variables can increase or decrease your risk of developing long-term side effects of radiotherapy. Some of these are:
- Your age at the time of radiation
- The dose of radiation you receive
- The number of treatment sessions
- The type of cancer treated
- The area of the body that receives radiation
- Other cancer treatments, such as chemotherapy
- Other health conditions, such as heart disease or diabetes
Faq: Radiation Therapy For Prostate Cancer
Why would I choose radiation therapy?
Radiation therapy, including external beam radiation therapy and brachytherapy, is an alternative form of treatment for prostate cancer. EBRT may be used after other treatments, such as surgery, to manage cancer that has recurred or is at high risk of recurrence. Radiation therapy has an excellent record of success, providing long-term disease control and survival rates equivalent to other treatments, including surgery.
How should I expect to feel during radiation therapy?
Undergoing external beam radiation therapy is similar to having a routine X-ray. Radiation cannot be seen, smelled or felt. Generally, side effects don’t appear until the second or third week of treatment. Because radiation therapy is a local treatment, only the areas of the body where it is directed will experience side effects. Most patients will experience some or all of the following:
- Increase in the frequency of urination
- Urinary urgency
- Softer and smaller volume bowel movements
- Increased frequency of bowel movements
- Worsening of hemorrhoids or rectal irritation with occasional scant blood and fatigue
Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.
How should I expect to feel after radiation therapy?
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What Is Radiation Recall
Radiation recall is a rash that looks like a severe sunburn. It is rare but it can happen when certain types of chemotherapy are given during or soon after external-beam radiation therapy.
The rash appears on the part of the body that received radiation therapy. Symptoms may include redness, tenderness, swelling, wet sores, and peeling skin.
Typically, these effects start within days or weeks of starting radiation therapy. But they can also appear months or years later. Doctors treat radiation recall with medications called corticosteroids. Rarely, it may be necessary to wait until the skin heals to continue with chemotherapy.
Coping With The Late Effects Of Chemotherapy
Long-term effects and late effects of cancer treatment are common. Many people find that their ânew normalâ is not what they would like, and feel frustrated by the symptoms. Cancer survival is improving. Itâs only very recently that the term âsurvivorshipâ was coined, and the long-range physical, emotional, and spiritual aspects of surviving cancer are becoming better understood.
Many of the larger cancer centers now provide cancer rehabilitation to help people maximize their new normal. The STAR program for cancer rehabilitation was designed specifically to address symptoms that prevent cancer survivors from enjoying the quality of life they otherwise can.
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Urinary And Sexual Function
Perhaps the 2 most feared complications of RP from a patientâs perspective are urinary complications and impotence. One difficulty in assessing these complications is that there are no precise definitions of incontinence or impotence in the literature. Furthermore, centers have obtained their outcomes data by widely divergent methods, including questionnaires, telephone interviews, or surgeon assessment. Lastly, continence and potency rates are improved when the patient population is highly selected .
Urinary incontinence can be a devastating complication following prostatectomy. Given the difficulty in measuring this clinical outcome, however, continence results in the literature vary widely. Most centers with a high-volume experience in this procedure report continence rates between 80% and 95% .
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What Is Complementary Medicine
Complementary and alternative medicine are medicines and health practices that are not standard cancer treatments. Complementary medicine is used in addition to standard treatments, and alternative medicine is used instead of standard treatments. Meditation, yoga, and supplements like vitamins and herbs are some examples.
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If Youre Getting Radiation Therapy To The Head Or Neck
People who get radiation to the head and neck might have side effects such as:
- Soreness in the mouth or throat
How to care for your mouth during treatment
If you get radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth, and throat. Here are some tips that may help you manage mouth problems:
- Avoid spicy and rough foods, such as raw vegetables, dry crackers, and nuts.
- Dont eat or drink very hot or very cold foods or beverages.
- Dont smoke, chew tobacco, or drink alcohol these can make mouth sores worse.
- Stay away from sugary snacks.
- Ask your cancer care team to recommend a good mouthwash. The alcohol in some mouthwashes can dry and irritate mouth tissues.
- Rinse your mouth with warm salt and soda water every 1 to 2 hours as needed.
- Sip cool drinks often throughout the day.
- Eat sugar-free candy or chew gum to help keep your mouth moist.
- Moisten food with gravies and sauces to make it easier to eat.
- Ask your cancer care team about medicines to help treat mouth sores and control pain while eating.
If these measures are not enough, ask your cancer care team for advice. Mouth dryness may be a problem even after treatment is over. If so, talk to your team about what you can do.
How to care for your teeth during treatment
Radiation treatment to your head and neck can increase your chances of getting cavities. This is especially true if you have dry mouth as a result of treatment.
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Your Bone Marrow And Blood
Chemotherapy can reduce the number of blood cells made by the bone marrow. Bone marrow is a spongy material that is found in the middle of your bones. It makes special cells called stem cells. These develop into the different types of blood cells:
- red blood cells, which carry oxygen to all parts of the body
- white blood cells, which fight and prevent infection
- platelets, which help the blood to clot and prevent bleeding and bruising.
You will have regular blood samples taken to check the number of these cells in your blood. This is called a full blood count.
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How Does Radiotherapy Work
Radiotherapy aims to destroy prostate cancer cells without causing too much damage to healthy cells. External beam radiotherapy uses high-energy X-ray beams targeted at the prostate from outside the body. These X-ray beams damage the cancer cells and stop them from growing and spreading to other parts of the body . Radiotherapy permanently damages and kills the cancer cells, but healthy cells can repair themselves and recover more easily.
You may have radiotherapy to a wider area, including the nearby lymph nodes and bones, if there is a risk that the cancer has spread there. Lymph nodes are part of your immune system and are found throughout your body. The lymph nodes in your pelvic area are a common place for prostate cancer to spread to. But if you do have radiotherapy to a larger area, you will be more likely to get side effects.
Which Approach Is Better: Active Surveillance Surgery Or Radiotherapy
The 10 year outcomes of the Prostate Testing for Cancer and Treatment trial from the United Kingdom has provided valuable insights into the management of localized PCa. The trial recruited 1643 men 50 to 69 years old. Of these 545 men underwent active surveillance, 553 surgery, and 545 radiotherapy. For the participants, the median follow-up was 10 years, the median age was 62 years, the median PSA was 4.6 , 77% were Gleason 6 and 21% were Gleason 7, and 76 % were T1c and the remaining T2. There were 17 prostate-cancerspecific deaths overall: 8 in the active surveillance group, 5 in the surgery group, and 4 in the radiotherapy group. The difference was not statistically significant among groups.
Metastases developed in more men in the active-monitoring group than in the surgery group or the radiotherapy group . Higher rates of disease progression were seen in the active-monitoring group than in the surgery group or the radiotherapy group . In summary, at a median of 10 years, prostate-cancerspecific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring, while 44% of the patients who were assigned to active monitoring did not receive radical treatment and avoided side effects.
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What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.
We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.
How Fertility Might Be Affected
For women: Talk to your cancer care team about how radiation might affect your fertility . Its best to do this before starting treatment so you are aware of possible risks to your fertility.
Depending on the radiation dose, women getting radiation therapy in the pelvic area sometimes stop having menstrual periods and have other symptoms of menopause. Report these symptoms to your cancer care and ask them how to relieve these side effects.Sometimes menstrual periods will return when radiation therapy is over, but sometimes they do not.
See Fertility and Women With Cancer to learn more.
For men: Radiation therapy to an area that includes the testicles can reduce both the number of sperm and their ability to function. If you want to father a child in the future and are concerned about reduced fertility, talk to your cancer care team before starting treatment. One option may be to bank your sperm ahead of time.
See Fertility and Men With Cancer to learn more.
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Talking To Your Oncology Team About Side Effects
Our radiation oncologists throughout the Atlanta area help patients manage side effects from lung cancer radiation every day. Dont be embarrassed or feel like your case is unusual. Our team is here to help you beat cancer and feel your best. Well do all we can to relieve side effects of cancer treatment and help you recover.
Study Process And Results
Researchers working at 10 hospitals in Spain enrolled 355 men with newly diagnosed prostate cancer that was still confined to the prostate and seminal vesicles . The men were divided into two groups: one group received a short course of hormonal therapy lasting four months, and the other group was treated for a longer duration of 24 months. All the patients were also treated with high-dose radiation.
After 10 years, only men who had been diagnosed initially with high-risk prostate cancer benefited from the long-term treatments. Specifically, 67.2% of these men avoided subsequent increases in prostate-specific antigen that signified worsening cancer. By contrast, 53.7% of men with high-risk cancer who received four months of hormonal therapy avoided similar PSA increases. Importantly, 78.5% of high-risk men who had long-term hormonal therapy were still alive after 10 years, compared to 67% of high-risk men treated with hormonal therapy for four months.
Among men with intermediate-risk prostate cancer, the duration of hormonal therapy made little difference. Just four men with intermediate-risk cancer developed worsening cancer that had spread to other sites in the body. Two came from the short-term treatment group, and two from the group that received hormonal therapy for 24 months. And after 10 years, none of the intermediate-risk patients had died from prostate cancer, regardless of how long the hormonal therapy treatments lasted.
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Brachytherapy For Prostate Cancer
Brachytherapy is a form of internal radiation therapy. With this type of therapy, radiation is delivered to the prostate tumor inside the body via a catheter or another implantable device.
High-dose rate brachytherapy uses radioactive Iridium-192 to deliver high doses of radiation to the prostate tumor. Treatments are short, sometimes requiring as few as five sessions. Brachytherapy radiation more tightly surrounds the tissues were targeting, which may help spare normal tissues.
Does Her2 Cause Breast Cancer To Grow Faster
HER2-positive tumors tend to grow faster than tumors that do not express the HER2 protein. However, recurrence rates vary and depend upon more than simply the HER2 status of the tumor. Like other breast cancers, recurrence rates depend upon the extent of spread of the tumor at the time of diagnosis
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Mouth And Throat Changes
Why it happens: Since chemo affects fast-growing cells, like the cells that line your entire GI tract , you may experience changes in these parts of your body.
Problems may include:
- Changes in taste and smell
- Infections in your gums, teeth or tongue
- Increased sensitivity to hot or cold foods
How to handle:
- Visit a dentist at least two weeks before starting chemo
- Check your mouth and tongue every day, especially if you wear dentures or a partial plate
- Keep your mouth moist by sipping water all day
- Brush your teeth with a soft toothbrush after every meal and at bedtime
- Do not use mouthwash that contains alcohol
- Take small bites of food
- Soften food with gravy, broth or other liquids
- Suck on popsicles or ice chips.
You cancer doctor or nurse may refer you to a dietitian who can provide further education.
How Long Does Chemotherapy Take For Breast Cancer
Typically, you receive chemotherapy in cycles. You may receive chemo every week or every two, three or even four weeks. Cycles are usually two to three treatments long. Each cycle includes a rest period to allow your body to recover. For example, you may have the same treatment every Monday for three weeks. Then you have an extra week to recover before repeating the cycle. Many people have multiple treatment cycles in a row. Treatment may last three to six months.
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Surgery For Prostate Cancer
A radical prostatectomy is the surgical removal of the prostate. This procedure may be performed through traditional open surgery, which involves one large incision in the abdomen. Laparoscopic surgery using the robotic daVinci® Surgical System is a minimally invasive alternative. Robotic surgery only requires a few small incisions in the abdomen, which may result in reduced pain, lower risk of infection and a shorter hospital stay after surgery.
The technology associated with the robotic surgical system is designed to give the surgeon greater precision and control, which may help spare healthy tissue and one or two of the nerve bundles on the sides of the prostate. This often allows the patient to have better erectile functionin both the short term and long term.
Problems With Your Bowels And Back Passage
Your bowel movements might be looser or more frequent than before your treatment. You might need to take anti diarrhoea medicines, such as loperamide . Bulking agents, such as Fybogel might also help.
You might find that you need to avoid high fibre foods as it might make long term diarrhoea worse. Some people find it best to avoid high fibre vegetables, beans and pulses .
Inflammation of the back passage is another possible long term side effect. Proctitis can cause a feeling of wanting to strain whether or not you actually need to pass a bowel movement. You might also have bleeding from your back passage or a slimy mucous discharge.
Talk to your doctor or specialist nurse if you have any of these side effects. They will be able to refer you to a specialist team that can help you to find ways of controlling the effects.
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