CANDO, Precious Gia G. NCM-105L AFPMC Prof.

Dawn Capaque
August 17, 2010
RADIATION THERAPY, NURSING CARE

I. Assessment of the situation

A. Definition
The therapeutic use of radium, radon, radioactive gold and other radioactive substances
to kill malignant cells, requiring special nursing care and consideration.

B. Rationales for actions

1. To prolong life by destroying malignant cells.
2. To aid in the patient’s comfort.
3. To cause partial or complete remission of the malignant process.

II. Nursing Plan

A. Objectives
1. To maintain a calm and reassuring manner.
2. To prepare the client adequately for the impressive size of the machinery use in
cobalt therapy and for possible side effects.
3. To maintain optimistic outlook.
4. To treat side effects and minimize discomfort.
5. To take adequate precautions to protect staffs, visitors and other clients from the
harmful effects of radiation.

B. Patient preparation
1. The machinery used to administer cobalt 60 is massive and may frighten the patient.
For their own protection, the personnel stand behind a lead screen or wall during the
treatment. For these reasons, the patient could find his first cobalt-60 treatment a terrifying
experience. Client must be adequately prepared in advance for the first sight of the equipment
and for the fact that she will be left alone. The nurse should explain that there is no pain or
sensation involved. Prior positive preparation can do much to help the patient accept these
treatments.
2. The patient should understand the reason for and expected effects of the treatment
before instigation. Before receiving a radioactive material, she should fully understand the care
she will receive, visitor limitations and restriction on herself.
3. The patient should be told that she will not feel the radiation itself. She may have
discomfort form the surgical implantation site; however there is no sensation in radiation
treatments.

C. Equipment
“Radiation Area” sign.

III. Implementing Nursing Intervention

A. Therapeutic aspects
1. Cobalt-60 Therapy
a. The cobalt-60 equipment is very large. There is no pain or sensation
involvement on the actual treatment; however, after the initial treatment patient should be told
that some side effects may occur; however, the nurse should avoid such statements as “People
always get nauseated from radiation therapy.” The goal is to decrease the patient’s fear and
anxiety if side effects do occur, not to increase her chances of having them by the power of
CANDO, Precious Gia G. NCM-105L AFPMC Prof. Dawn Capaque
August 17, 2010
suggestion. Usual side effects include nausea, vomiting, anorexia, skin reaction, malaise, and
alopecia. If skin reaction occurs, they must never be referred to as “radiation burns,” as this
implies carelessness. They should be called dermatitis or skin reactions.

B. Communicative Aspects
1. Observations
a. Observe for any reaction to therapy, and treat early. A bland cream may help
local skin reaction; vigorous rubbing should be discouraged. Anti-emetics help curb nausea.
b. Observe the patient’s reaction to the treatment for signs of acceptance of the
clinical diagnosis.
c. Observe the patient’s environment (e,g., linens, floor) for any signs of dislodge
radioactive materials.
2. Charting
3. Referrals

C. Teaching Aspects- Patient and Family

1. Help the patient’s family and friends understand the restrictions when they face when
visiting the patient. They will usually be more compliant if they know the reasons for these
restrictions. However, avoid unduly alarming the patient or her visitors.
2. Familiarize other personnel with the radioactivity sign and symbol and the precautions
to be taken.

IV. Evaluation Process

A. Did the patient face initiation of therapy calmly or with fear and apprehension?
B. If side effects occurred was the patient prepared and did she react positively?
C. Did side effects occur? Were they handled promptly and effectively?
D. Were proper safety measures carried out by everyone who came in contact with the
patient?

Reference:
Illustrated Manual of Nursing Techniques, 2nd edition by King, Wieck and Dyer
CANDO, Precious Gia G. NCM-105L AFPMC Prof. Dawn Capaque
August 17, 2010

Radiation Therapy 

Definition
Radiation therapy, sometimes called radiotherapy, x-ray therapy radiation treatment, cobalt
therapy, electron beam therapy, or irradiation uses high energy, penetrating waves or particles
such as x rays, gamma rays, proton rays, or neutron rays to destroy cancer cells or keep them
from reproducing.

Purpose
The purpose of radiation therapy is to kill or damage cancer cells. Radiation therapy is a
common form of cancer therapy. It is used in more than half of all cancer cases. Radiation
therapy can be used:

 alone to kill cancer

 before surgery to shrink a tumor and make it easier to remove
 during surgery to kill cancer cells that may remain in surrounding tissue after the
surgery (called intraoperative radiation)
 after surgery to kill cancer cells remaining in the body
 to shrink an inoperable tumor in order to and reduce pain and improve quality of life.
 in combination with chemotherapy

For some kinds of cancers such as early-stage Hodgkin's disease, non-Hodgkin's lymphoma, and
certain types of prostate, or brain cancer, radiation therapy alone may cure the disease. In
other cases, radiation therapy used in conjunction with surgery, chemotherapy, or both,
increases survival rates over any of these therapies used alone.

Precautions
Radiation therapy does not make the person having the treatments radioactive. In almost all
cases, the benefits of this therapy outweigh the risks. However radiation therapy can have has
serious consequences, so anyone contemplating it should be sure understand why the
treatment team believes it is the best possible treatment option for their cancer. Radiation
therapy is often not appropriate for pregnant women, because the radiation can damage the
cells of the developing baby. Women who think they might be pregnant should discuss this with
their doctor.

Description
Radiation therapy is a local treatment. It is painless. The radiation acts only on the part of the
body that is exposed to the radiation. This is very different from chemotherapy in which drugs
circulate throughout the whole body. There are two main types of radiation therapy. In external
radiation therapy a beam of radiation is directed from outside the body at the cancer. In
internal radiation therapy, called brachytherapy or implant therapy, where a source of
radioactivity is surgically placed inside the body near the cancer.
CANDO, Precious Gia G. NCM-105L AFPMC Prof. Dawn Capaque
August 17, 2010
How radiation therapy works
The protein that carries the code controlling most activities in the cell is called deoxyribonucleic
acid or DNA. When a cell divides, its DNA must also double and divide. High-energy radiation
kills cells by damaging their DNA, thus blocking their ability to grow and increase in number.
One of the characteristics of cancer cells is that they grow and divide faster than normal cells.
This makes them particularly vulnerable to radiation. Radiation also damages normal cells, but
because normal cells are growing more slowly, they are better able to repair radiation damage
than are cancer cells. In order to give normal cells time to heal and reduce side effects,
radiation treatments are often given in small doses over a six or seven week period.

External radiation therapy

External radiation therapy is the most common kind of radiation therapy. It is usually done
during outpatient visits to a hospital clinic and is usually covered by insurance.
Once a doctor, called a radiation oncologist, determines the proper dose of radiation for a
particular cancer, the dose is divided into smaller doses called fractions. One fraction is usually
given each day, five days a week for six to seven weeks. However, each radiation plan is
individualized depending on the type and location of the cancer and what other treatments are
also being used. The actual administration of the therapy usually takes about half an hour daily,
although radiation is administered for only from one to five minutes at each session. It is
important to attend every scheduled treatment to get the most benefit from radiation therapy.
Recently, trials have begun to determine if there are ways to deliver radiation fractions so that
they kill more cancer cells or have fewer side effects. Some trials use smaller doses given more
often.

The type of machines used to administer external radiation therapy and the material that
provides the radiation vary depending on the type and location of the cancer. Generally, the
patient puts on a hospital gown and lies down or sits in a special chair. Parts of the body not
receiving radiation are covered with special shields that block the rays. A technician then directs
a beam of radiation to a pre-determined spot on the body where the cancer is located. The
patient must stay still during the administration of the radiation so that no other parts of the
body are affected. As an extra precaution in some treatments, special molds are made to make
sure the body is in the same position for each treatment. However, the treatment itself is
painless, like having a bone x-rayed.

Internal radiation therapy

Internal radiation therapy is called brachytherapy, implant therapy, interstitial radiation, or
intracavitary radiation. With internal radiation therapy, a bit of radioactive material is sealed in
an implant (sometimes called a seed or capsule). The implant is then placed very close to the
cancer. The advantage of internal radiation therapy is that it concentrates the radiation near the
cancer and lessens the chance of damage to normal cells. Many different types of radioactive
materials can be used in the implant, including cesium, iridium, iodine, phosphorus, and
palladium.
How the implant is put near the cancer depends on the size and location of the cancer. Internal
radiation therapy is used for some cancers of the head, neck, thyroid, breast, female
reproductive system, and prostate. Most people will have the radioactive capsule implanted by a
surgeon while under either general or local anesthesia at a hospital or surgical clinic.
Patients receiving internal radiation therapy do become temporarily radioactive. They must
remain in the hospital during the time that the implant stays in place. The length of time is
CANDO, Precious Gia G. NCM-105L AFPMC Prof. Dawn Capaque
August 17, 2010
determined by the type of cancer and the dose of radioactivity to be delivered. During the time
the implant is in place, the patient will have to stay in bed and remain reasonably still.
While the implant is in place, the patient's contact with other people will be limited. Healthcare
workers will make their visits as brief as possible to avoid exposure to radiation, and visitors,
especially children and pregnant women, will be limited.
The implant usually can be removed in a simple procedure without an anesthetic. As soon as
the implant is out of the body, the patient is no longer radioactive, and restrictions on being
with other people are lifted. Generally people can return to a level of activity that feels
comfortable to them as soon as the implant is removed. Occasionally the site of the implant is
sore for some time afterwards. This discomfort may limit specific activities.
In some cases, an implant is left permanently inside the body. People who have permanent
implants need to stay in the hospital and away from other people for the first few days.
Gradually the radioactivity of the implant decreases, and it is safe to be around other people.

Radioimmunotherapy
Radioimmunotherapy is a promising way to treat cancer that has spread (metastasized) to
multiple locations throughout the body. Antibodies are immune system proteins that specifically
recognize and bind to only one type of cell. They can be designed to bind only with a certain
type of cancer cell. To carry out radioimmunotherapy, antibodies with the ability to bind
specifically to a patient's cancer cells are attached to radioactive material and injected into the
patient's bloodstream. When these man-made antibodies find a cancer cell, they bind to it.
Then the radiation kills the cancer cell. This process is still experimental, but because it can be
used to selectively attack only cancer cells, it holds promise for eliminating cancers that have
spread beyond the primary tumor.

Radiation used to treat cancer

PHOTON RADIATION. Early radiation therapy used x rays like those used to take pictures of
bones, or gamma rays. X rays and gamma rays are high energy rays composed of massless
particles of energy (like light) called photons. The distinction between the two is that gamma
rays originate from the decay of radioacive substances (like radium and cobalt-60), while x rays
are generated by devices that excite electrons (such as cathode ray tubes and linear
accelerators). These high energy rays act on cells by disrupting the electrons of atoms within
the molecules inside cells, disrupting cell functions, and most importantly stop their ability to
divide and make new cells.
PARTICLE RADIATION. Particle radiation is radiation delivered by particles that have mass.
Proton therapy has been used since the early 1990s. Proton rays consist of protons, a type of
positively charged atomic particle, rather than photons, which have neither mass nor charge.
Like x rays and gamma rays, proton rays disrupt cellular activity. The advantage of using proton
rays is that they can be shaped to conform to the irregular shape of the tumor more precisely
than x rays and gamma rays. They allow delivery of higher radiation doses to tumors without
increasing damage to the surrounding tissue.
Neutron therapy is another type of particle radiation. Neutron rays are very high-energy rays.
They are composed of neutrons, which are particles with mass but no charge. The type of
damage they cause to cells is much less likely to be repaired than that caused by x rays,
gamma rays, or proton rays.
Neutron therapy can treat larger tumors than conventional radiation therapy. Conventional
radiation therapy depends on the presence of oxygen to work. The center of large tumors lack
sufficient oxygen to be susceptible to damage from conventional radiation. Neutron radiation
CANDO, Precious Gia G. NCM-105L AFPMC Prof. Dawn Capaque
August 17, 2010
works in the absence of oxygen, making it especially effective for the treatment of inoperable
salivary gland tumors, bone cancers, and some kinds of advanced cancers of the pancreas,
bladder, lung, prostate, and uterus.

Recent advances in radiation therapy

A newer mode of treating brain cancers with radiation therapy is known as stereotactic
radiosurgery. As of the early 2000s, this approach is limited to treating cancers of the head and
neck because only these parts of the body can be held completely still throughout the
procedure. Stereotactic radiosurgery allows the doctor to deliver a single high-level dose of
precisely directed radiation to the tumor without damaging nearby healthy brain tissue. The
treatment is planned with the help of three-dimensional computer-aided analysis of CT and MRI
scans. The patient's head and neck are held steady in a skeletal fixation device during the
actual treatment. Stereotactic radiosurgery can be used in addition to standard surgery to treat
a recurrent brain tumor, or in place of surgery if the tumor cannot be reached by standard
surgical techniques.
Two major forms of stereotactic radiosurgery are in use as of 2003. The gamma knife is a
stationary machine that is most useful for small tumors, blood vessels, or similar targets.
Because it does not move, it can deliver a small, highly localized and precise beam of radiation.
Gamma knife treatment is done all at once in a single hospital stay. The second type of
radiosurgery uses a movable linear accelerator-based machine that is preferred for larger
tumors. This treatment is delivered in several small doses given over several weeks.
Radiosurgery that is performed with divided doses is known as fractionated radiosurgery. The
total dose of radiation is higher with a linear accelerator-based machine than with gamma knife
treatment.
Another advance in intraoperative radiotherapy (IORT) is the introduction of mobile devices that
allow the surgeon to use radiotherapy in early-stage disease and to operate in locations where
it would be difficult to transport the patient during surgery for radiation treatment. Mobile IORT
units have been used successfully as of 2003 in treating early-stage breast cancer and rectal
cancer.
Radiation sensitizers are another recent innovation in radiation therapy. Sensitizers are
medications that are given to make cancer cells easier to kill by radiation than normal calls.
Gemcitabine (Gemzar) is one of the drugs most commonly used for this purpose.

Preparation
Before radiation therapy, the size and location of the patient's tumor are determined very
precisely using magnetic resonance imaging (MRI) and/or computed tomography scans (CT
scans). The correct radiation dose, the number of sessions, the interval between sessions, and
the method of application are calculated by a radiation oncologist based on the tumor type, its
size, and the sensitivity of the nearby tissues.
The patient's skin is be marked with a semipermanent ink to help the radiation technologist
achieve correct positioning for each treatment. Molds may be built to hold tissues in exactly the
right place each time.

Aftercare
Many patients experience skin burn, fatigue, nausea, and vomiting after radiation therapy
regardless of the where radiation is applied. After treatment, the skin around the site of the
treatment may also become sore. Affected skin should be kept clean and can be treated like
CANDO, Precious Gia G. NCM-105L AFPMC Prof. Dawn Capaque
August 17, 2010
sunburn, with skin lotion or vitamin A and D ointment. Patients should avoid perfume and
scented skin products and protect affected areas from the sun.
Nausea and vomiting are most likely to occur when the radiation dose is high or if the abdomen
or another part of the digestive tract is irradiated. Sometimes nausea and vomiting occur after
radiation to other regions, but in these cases the symptoms usually disappear within a few
hours after treatment. Nausea and vomiting can be treated with antacids, Compazine, Tigan, or
Zofran.
Fatigue frequently starts after the second week of therapy and may continue until about two
weeks after the therapy is finished. Patients may need to limit their activities, take naps, and
get extra sleep at night.
Patients should see their oncologist (cancer doctor) at least once within the first few weeks
after their final radiation treatment. They should also see an oncologist every six to twelve
months for the rest of their lives so they can be checked to see if the tumor has reappeared or
spread.

Risks
Radiation therapy can cause anemia, nausea, vomiting, diarrhea, hair loss, skin burn, sterility,
and rarely death. However, the benefits of radiation therapy almost always exceed the risks.
Patients should discuss the risks with their doctor and get a second opinion about their
treatment plan.

Normal results
The outcome of radiation treatment varies depending on the type, location, and stage of the
cancer. For some cancers such as Hodgkin's disease, about 75% of the patients are cured.
Prostate cancer also responds well to radiation therapy. Radiation to painful bony metastases is
usually a dramatically effective form of pain control. Other cancers may be less sensitive to the
benefits of radiation.
CANDO, Precious Gia G. NCM-105L AFPMC Prof. Dawn Capaque
August 17, 2010

Reference:
http://medical-dictionary.thefreedictionary.com/Cobalt+therapy
About Radiation Therapy Treatment for Cervical Cancer

Cervical cancer is nearly 100 percent curable when identified and treated in the early stages.
Radiation therapy is one of the most effective ways to treat cervical cancer in the early stages.
Radiation oncologists can administer radiation therapy externally, internally and in combination.
Since 1940, with the introduction of the pap test--a routine pelvic exam for women over a
certain age and those who exhibit risk factors-- incidents of cervical cancer that result in death
has plummeted by 75 percent.

Early Diagnosis and Prevention

 Cervical cancer grows slowly; that's why annual pelvic exams are so effective in detecting it
early. Cervical cancer begins with normally healthy cells in the cervix -- the inch-long canal at
the lower end of the uterus that connects to the back end of the vagina -- begin to mutate,
developing abnormally. While cervical cancer is highly treatable, more than a third of the
women diagnosed with the disease each year die from it, with nearly 4,500 cervical cancer
deaths per year. Those who succumb to the disease often failed to get preventative screening;
many die because the cancer was not discovered early enough to treat effectively.
Stages of Cervical Cancer
CANDO, Precious Gia G. NCM-105L AFPMC Prof. Dawn Capaque
August 17, 2010


Development of cervical cancer
Changes to the cervix at the cellular level often present the first indication of cervical cancer.
While cellular mutations are not necessarily cancerous, cervical intraepithelial neoplasia (CIN),
or cervical dysplasia, is often detected in women prior to a cervical cancer diagnosis.
Noninvasive carcinoma, a very early form of cervical cancer, affects only the outer layer of
cervical cells. If left untreated the cancer penetrates deeper into the cervix and the cancer
becomes much more difficult to treat.
Even the more advanced form of cervical cancer, known as invasive cervical cancer (ICC) is still
almost 100 percent curable if caught before it penetrates the cervix too deeply or spreads to
other organs. At this stage, cancer has penetrated deep into the cervix and possibly into
neighboring tissues and organs. If not diagnosed before it reaches a severe level of penetration
and spreads beyond the reproductive tract, invasive cervical cancer kills 95 percent of those
afflicted.

Radiation Therapy for Cervical Cancer

 The most effective way to eradicate cervical cancer is to excise the cancerous cells before
they penetrate beyond the lining of the cervix. To do this effectively, radiation therapy is a
common form of treatment. When a patient's cervical cancer is more advanced, radiation
therapy is often used in combination with chemotherapy. Radiation oncologists administer
radiation therapy both internally and externally and sometimes administer both forms
simultaneously when treating patients with more advanced cervical cancer

Side Effects
 Radiation treatment itself is not painful; however, patients often suffer extensively as a
result of the treatment's side effects. Side effects commonly experienced by patients include
tiredness, decreased energy, frequent or uncomfortable urination, and loose stool or diarrhea.
Patients may also experience skin irritation and lose pubic hair. One of the most serious side
effects of radiation therapy in cervical cancer treatment is its potential to prevent the ovaries
from functioning, which induces early-onset menopause in younger women.
Problems with the vagina are known to arise after radiation treatment. Increased tightness and
a lack of flexibility may make sexual encounters and pelvic exams painful or uncomfortable.
Many patients are instructed to counteract this tightening effect by using a dilator during the
CANDO, Precious Gia G. NCM-105L AFPMC Prof. Dawn Capaque
August 17, 2010
course of treatment.

Reference:
http://www.ehow.com/about_5079106_radiation-therapy-treatment-cervical-cancer.html