The document provides information about cancer treatment options including radiation therapy. It discusses the various types of radiation therapy such as external beam radiation therapy and brachytherapy. Brachytherapy can be sealed or unsealed sources placed inside or near the tumor. Nursing care focuses on safety measures to minimize radiation exposure for staff and visitors. Common side effects from radiation like skin reactions, mucositis, xerostomia, and diarrhea are described along with symptom management strategies.

1. Warning Signs
 C—Change in Bowel or Bladder habits
 A—A Sore doesn’t Heal
 U—Unusual Bleeding or Discharge
 T—Thickening or lump in breast or
elsewhere
 I—Indigestion or difficulty swallowing
 O—Obvious change in warts or moles
 N—Nagging Cough or Hoarseness
CAUTION

2. Cancer Treatment
 Based on Cell Origin
 Focus on Removing or Destroying cancer cells
 Guide by Client Factors
 Adjuvant treatment
 Hormone
 Radiation
 Targeted Therapies
 Immunotherapy
 Chemotherapy

3. RADIATION
THERAPY
DEPARTMENT OF MEDICAL
SURGICAL NURSING
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4. Radiation Therapy
Definition
Sources of radiation.
Goals of radiotherapy.
Mechanism of action.
Principles of radiation protection.
Types of radiation therapy.
Care of clients receiving radiation
therapy.
Side effects & symptom management.
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5. RADIOTHERAPY
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◦ One way to stop the cancer from growing is to interfere
with the cancer cell’s ability to multiply.
◦ Radiation at high dosages causes changes in the cancer
cells that stops the cell’s ability to multiply and
eventually kills the cancer cell.
◦ In some cases, it destroys cancer cell, while in others, it
slows down the growth.

6. Radiotherapy
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RADIOTHERAPY is the treatment of neoplastic
disease using high energy ionizing rays (x-rays or
gamma rays) to kill cancer cells.
These may be generated by radioactive sources or
linear accelerators.
The Higher The Energy Of The Photon, The Deeper It
Can Penetrate The Body Before Losing Its Effect.
Radiation deters the proliferation of malignant cells by
decreasing the rate of mitosis or impairing DNA
synthesis.

7. Sources of Radiation
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 COLBALT 60
 CESIUM 137
 IODINE 131
 IRIDIUM 192
 RADIUM 226
 RADON 222
 STRONTIUM 90

10. Gamma & X-rays
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High Energy
Ionizing

11. Goals of Radiotherapy
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• Curative
• Control:
•Adjuvant
•Pre/Post Operative
•Intraoperative
• Palliation

12. • Radiation therapy may be curative in many
types of cancer if they are localized to one
area of the body.
• It may also be used as a part of therapy,
e.g.. after performing surgery for removing a
primary malignant tumor, it can be used to
prevent tumor recurrence ( for example,
early stages of breast cancer). It is common
to combine radiation therapy with surgery,
chemotherapy, hormone therapy and
immunotherapy.
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13.  It is synergistic with chemotherapy, and
has been used before, during and after
chemotherapy in susceptible cancers.
 It may also be used as palliative treatment
where cure is not possible and the aim is
for local disease control or symptomatic
relief.

14. • Ionizing radiation works by damaging the DNA of
cancerous tissue leading to cellular death.
• Tospare normal tissues, shaped radiation beams
are aimed from several angles of exposure to
intersect at the tumor, providing a much larger
absorbed dose there than in the surrounding
healthy tissues.
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15. Radiation Protection:
Principles
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ALARA Principle The physical protection against
external radiation is based on the
following three principles:
-distance from the source of
radiation (distance),
-limitation of the time of irradiation
(time),
-absorption of radiation (shielding).

16. Time
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m
Minimize time spent in close
proximity to the patient. Radiation
exposure is directly related to the
time spent within a specific distance
of radiation source. Care giver
should not exceed 1/2 to 1 hour
exposure per shift.
◦ Organize care, prior to entering room.
◦ Assemble all equipment, prior to roo
entry
◦ In room, place supplies/equipment
within easy quick access.
◦ Post time guidelines on door.

17. Distance
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The amount of radiation decreases with
increase in distance.
Doubling the distance from the radiation
source, Quarters the amount of radiation
received.
If the exposure at 1 meter from the Radiation
Source is X, the exposure at 2m is ¼ of x, and
at 4m, one sixteenth.
Interventions:
Teach patient self-care & rationale for isolation.
Limit patient care by individual caregiver.
Use communication devices outside room to
interact whenever possible.

18. Shielding
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When used properly, lead shielding
can provide added protection from
radiation.
In practice, nurses find lead shielding
apron cumbersome to work with.
Nurses wear a film badge.
NB: Pregnant nur
for radiation patie
ses should not care
nts.

19. Types of Radiation Therapy
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External Beam or Teletherapy
• most common type of radiation therapy using
machine (linear accelerator).
• patient is not radioactive.
Internal radiation or Brachytherapy
• implant is placed inside patient
temporary/permanent.
• patient is radioactive.

20. Teletherapy
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Delivering radiation from a source at a
distance from the target.
Radiation department administers the
dose.
Advantage: skin sparring effect, giving
max radiation to tumor not the skin.
Patient is monitored via TV or intercom
Treatment approx. 10 minutes.
Not painful, though patient may feels
heat or tingling.

21. EXTERNAL BEAM
RADIATION THERAPY
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22. Brachytherapy
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Delivers a high dose of radiation to a localized area.
The specific radioisotope is chosen on the basis of
its half-life
Brachytherapy may be sealed or unsealed:
SEALED:
Interstitial
Intracavitary
UNSEALED:
Systemic (IV, oral)

23. Brachytherapy
 SEALED
 Emits low energy
 continuously
Interstitial &
intracavitary
implants
 Ex. Seeds,
 APPLICATORS
PATIENT EMITS
RADIATION but
 NONE IN EXCRETA
 UNSEALED
Injected, instilled or
oral.
Systemically
EX. I131
PATIENTAND
EXCRETA are
RADIOACTIVE
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24. Sealed Brachytherapy:
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Intracavitary:
Radioisotopes (cesium or radium) put inside
the applicator & placed in body cavity for a
specific amount of time (24-72hours)
When treatment completed, applicator &
radioactive material removed
treats cancer of uterus & cervix.
Interstitial:
needles, beads, seeds, ribbons or catheters
are placed directly into tumor (breast,
prostrate)
Radioisotopes: iridium, cesium, gold, radon
Placement can be temporary or permanent
Treats Prostrate, cervical, esophagus
cancer etc.

25. BRACHYTHERAPY
APPLICATORS
Fletcher-Suit applicator
Radioactive seeds implanted in prostate 20

26. Nursing Care of the
patient with Sealed
ImplantProvide Private room with bathroom
Radioactive material sign should be placed
outside
Wear dosimeter
No pregnant staff
Visitors limited to 30 mins per day
Visitors are restricted and must remain at 6 feet
distance
All dressings & linens saved until implant
removed
LEAD CONTAINER & LONG HANDLED
FORCEPS,LEAD GLOVES KEPT IN ROOM IN
EVENT OF DISLODGEMENT
REMEMBER ALARA
TIME
DISTANCE
SHEILDING 21

27. Nursing Care of patient
with UNSEALED Implant
Presents potential contamination hazard.
All articles in room are considered
contaminated.
After discharge, articles are discarded but
taken to protected area ‘till detectable
radioactivity decays’.
Rubber gloves worn with direct care
No pregnant staff
Articles in room: phone, call light, floors
covered with plastic.
Disposable plastic /paper should be used for
dietary trays & utensils.
Flush toilet used by patient several times.
Keep linen & gowns kept in separate isolation
bags 22

28. Loss of Radioactive Material
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Considered an emergency.
Search should initiated by radiation
staff.
Removes nothing from the room
while patient has radioactive
material in place.
If radioactive material is found, use
long handled forceps & gloves.
Notify Atomic Energy Center.

29. RADIATION THERAPY : INJURY
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Phases of Radiation Injury:
Early (acute) Phase: occurs within weeks and resolve
4-6 weeks post radiation. Usually temporary and
affect tissues with rapidly dividing cells (skin,
mucous membranes)
Late Phase: may occur months/years later and
usually result from damage to the micro-circulation.
Affect any/all tissues especially: lymph, thyroid,
pituitary, breast, brain, bone, cartilage, pancreas
and bile ducts.

30. SIDE EFFECTS OF
RADIATION THERAPY
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Factors influencing degree & occurrence of
side effects due to Radiotherapy
Body site irradiated
Dosage
Extent of body area treated
Method of radiation delivery
Age of client
General health of client
Previous surgeries & chemotherapy
Radiosensitivity of tissue/organ treated.

31. Symptom Management in
Radiation Oncology
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Nausea & vomiting
Diarrhea
Xerostomia
Ocular symptoms ( edema, dryness, photophobia)
Oral mucositis
Alopecia
Hyperthermia
Headache
Cystitis
Esophagitis

32. Skin Reactions
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Acute: begin about 2 weeks after start
of treatment and resolve over next 3-4
weeks. Reactions include erythema,
dry desquamation, wet desquamation
Chronic: may occur years later and
include atrophy, pigm
fibrosis and telangiec
ent changes,
tasia.

33. Dry desquamation
Begins within 7-10 days of treatment
Erythema that may progress to dry, itchy skin
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May be scaling, flaking, peeling
Result of partial loss of the epidermal basal
cell layer.
Wet desquamation
Result of complete destruction of the basal cell
layer
Blister, vesicles, and serous oozing occur
Pain may occur if nerve endings are exposed
Occurs more often in areas of friction &
moisture (skin fold, groins)
Increased risk of infection (may require break
in treatment)

34. General Skin Care
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Wash daily with water or mild scent-free soap
Use hand to wash the area.
Rinse soap well.
Pat skin dry.
Don't use powders, creams unless ordered by
Oncologist.
Wear soft clothing over radiation site (cotton).
Avoid belts, straps & tight clothing.
Avoid sun exposure.
Shave with electric razor.
Do not use tape over site.

35. Alopecia
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May occur within the treatment field.
Extent depends upon area of
treatment and dose of XRT.
Often patchy in appearance.
Usually begins 2 weeks after start of
XRT.
Usually temporary, but ma
permanent.
Regrowth usually begins
y be
3-6months.

36. Mucositis
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hroat
oat”
ons
Inflammation of the mucosal lining of the G.I.
tract
• If oral cavity - stomatitis
• If esophagus – esophagitis
Common in patients receiving RT to head & neck
Severity depends on dose, size of field, and
fractionation schedule of RT
Symptoms include:
Soreness or burning in mouth/ t
Difficulty swallowing
Sensation of “having lump in thr
Redness, tenderness, or ulcerati
in the mouth

37. Assessment of mucositis
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History
- Oral symptoms
- Food and fluid intake
- Difficulty swallowing
Physical
- Assess oral cavity for redness, inflammation, ulcers, infection
Investigations
-Take culture Swab of lesions if Candida or herpes suspected

38. MUCOSITIS
INTERVENTION
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Instruct patient/caregiver to:
Gently brush all surfaces of teeth, gums, and tongue
with a soft nylon brush.
Brush with a nonirritating dentifrice such as baking
soda.
Remove and brush dentures thoroughly during and
after meals and as needed.
Rinse the mouth thoroughly during and after brushing
Avoid alcohol-containing mouthwashes.
Use recommended mouth rinses:
o Hydrogen peroxide and saline or water (1:2 or 1:4).
o Baking soda and water (1 tsp in 500 ml).
o Salt (.5 tsp), baking soda (1 tsp), and water (100 ml).
Keep lips moist.
Avoid use of tobacco and alcohol.

39. Xerostomia
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Dryness in the mouth caused by lack
of normal secretion of saliva
Salivary glands very sensitive to RT
Severity related to dose
May be permanent with higher doses
Lack of moisture to mucosa causes
irritation to the mucosa, fissures may
develop on the corners of the mouth
Xerostomia promotes accumulation
of bacteria and plaque increasing
susceptibility to infection, dental
caries, and periodontal disease

40. Xerostomia Interventions
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Good oral hygiene
Frequent sips water, sugarless gum, avoid dry
foods, liquids with meals
Avoid alcohol and smoking
Humidifier
Artificial saliva i.e. Moistir ac meals, hs, & prn
Pilocarpine for radiation induced Xerostomia

41. Diarrhea
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nto
Passage of frequent (more than 3/24hrs), loose,
watery stool
Can lead to dehydration, malabsorption, fatigue,
hemorrhoids, and perianal skin breakdown
Caused by irritation/inflammation of the bowel
lining
Risk for Diarrhea
Higher in patients undergoing chemo or RT to
abdomen or pelvis
With XRT usually develops 10-15 days i
treatment
Lasts 2-3 weeks after treatment

42. Assessment of Diarrhea
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History - onset, pattern, number of
B.M.’s/24 hrs.
Physical – vital signs, assess
hydration status
Psychological – anxiety, stress
Investigations – serum electrolytes,
creatinine & urea, stool cultures &
stool for c. difficile

43. Interventions
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Radiation induced diarrhea usually managed
initially with dietary changes
- Small freq. meals
- Drink 8-10 glasses of fluids
- Low fat, low fiber diet
- Avoid gas producing foods
- Avoid caffeinated beverages
Loperamide – if patient has more than 3 watery
B.M.’s per day
Protect peri-anal area form skin breakdown
- Keep area clean and dry
- Sitz bathes several times a day can ease
discomfort

44. Other complications
radiation treatment
 Cystitis (usually occurs 1-2 weeks post
XRT and subsides 2 weeks after XRT
complete
 Lhermitte’s syndrome – after spinal
cord radiation
 Vaginal stenosis – after XRT to pelvis
 Radiation pneumonitis – after XRT to
lungs
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