What to Expect During Treatment

Fighting cancer is challenging. To help you prepare for the fight, here is a brief outline of what you can expect during treatment with radiotherapy or radiosurgery. The details of some of the steps may differ, depending on your particular case.

Step 1: The Consultation

First, you'll meet with your doctor, a radiation oncologist, to discuss your treatment. Based on your specific case, your radiation oncologist will tell you what type of radiation therapy he or she recommends, whether it will be given alone or in conjunction with other treatment methods, what the specific goals of treatment are, and what side effects you may experience. You can talk to your radiation oncologist about your treatment options and make a decision together. The consultation is an excellent opportunity for you to ask your radiation oncologist whatever questions you may have. Click here for a list of common questions.

Step 2: Imaging

In order for the radiation oncologist to design your treatment, the exact size and location of the tumor must first be determined. This is usually done by creating a detailed 3-D image of the tumor with a CT scan. Depending on the general location of the tumor, disease type and other factors, additional scans may be taken, which could include an MRI, a PET scan or an ultrasound scan. Your oncologist can rotate the image on his computer screen to view the tumor from every angle.

It is very important that the position in which you are scanned is reproduced at the time of treatment. Sometimes temporary skin marks and even tiny tattoos (about the size of a freckle) are made on your body to help the radiation therapist (RT) position you correctly each day for treatment. Depending on the location of the tumor, a body mold, head mask or other device may be constructed to make it easier for you to remain in the same position during treatment.

Step 3: Treatment Planning

Once your scans have been completed, your doctor, the medical physicist and the dosimetrist will meet to design your treatment plan. They take many factors into account when they design the treatment plan. These can include the type of cancer, its location and size, your medical history, and your lab test results. Based on these factors, the treatment plan specifies the amount of radiation to be delivered, the appropriate angles from which to deliver it, and the number of sessions needed to deliver the prescribed treatment.

Step 4: Getting Positioned for Treatment

Before each day's treatment, you may be asked to change into a gown. The radiation therapist (RT) will help you get positioned on the treatment "couch" — a platform designed to work with the radiation machine. If a facemask, mold or other device was created for you during the imaging process, it will be placed on you or under you at this time. The couch will be adjusted so a laser light shines on the mark that was put on your skin, helping to position you correctly. Depending on the type of machine you’re treated on, your treatment team may take a scan immediately prior to treatment, while you are on the couch. The purpose of this new scan is to show if the tumor has changed in size or position since the first one was created during imaging. If it reveals any changes, the RT will make the necessary adjustments to the position of the couch to ensure that you are properly aligned for treatment.

Step 5: Treatment Begins

The radiation is delivered by a machine called a linear accelerator, or linac. Most linacs have a gantry, which is the head of the machine. The gantry houses a device called a multi-leaf collimator that "shapes" the radiation beam so it conforms to the shape of the tumor from any given angle. During your treatment, the gantry will move around you to deliver the radiation. The radiation beam is not visible to the eye, so you will not see it when it leaves the gantry.

Your first two treatments may take 15 minutes or more, as your radiation therapist helps you get into position and takes images to verify that your setup on the machine is the same as the treatment plan. Subsequent treatments, however, are often shorter. In fact, some treatments — from entering the waiting room to leaving the clinic — can take as little as 12 to 30 minutes.

Step 6: Post-Treatment and Follow-Ups

You may experience some side effects from radiotherapy. If you do, they might not begin until after several sessions because the effects of radiation treatment are cumulative. Talk to your oncologist before and during treatment if you have any questions or experience discomfort. Learn more about possible side effects.

After your treatment has ended, your radiation oncologist will recommend a schedule for periodic checkups to monitor the results. Typically, the first checkup is given in one to three months, and subsequent checkups are scheduled at six-month intervals, but yours may be more or less frequent, depending upon your situation. If symptoms or clinical circumstances suggest a recurrence, diagnostic tests such as blood tests, ultrasound scans, CT scans, MRIs, chest x-rays (CXR), or bone scans may be needed.