Communication is of extreme importance; your team of doctors, nurses and staff will collaborate with you to be sure that your individualized care and treatment plan is followed and updated, as needed.
We encourage patients to take an active role in their own care. Talking with your team will assure that all aspects of your cancer treatment work together to provide the best outcome.
Patients have the advantage of seeing a medical oncologist, radiation oncologist and surgeon all in one visit. “This new generation of treatment technology represents a major step in the fight against cancer.” Using a team approach, our professionals work together to consider all treatment options and develop an individual treatment plan for each patient.
Treatment options are varied and you may have surgery, chemotherapy, radiation therapy or a combination of all three. It depends on the type and stage of your cancer. Our certified nursing staff will explain treatment protocols and review any potential side effects. Treatment will take place at one of our clinics or in a hospital.
El Portal Comprehensive Cancer Centers Expert Medical Oncologist (EPCCC), we’re here to help you find answers and understand the steps we take to diagnose and treat you. Below you will find a step-by-step explanation of what to expect when you become an EPCCC patient. Always feel free to contact us directly if you have questions or concerns.
You’ll be interviewed and examined by one of our physicians, an oncologist, hematologist or urologist, depending on your condition. The doctor who referred you (probably your primary care physician) will have provided your medical records, but we will also ask you to fill out paperwork about your health history, medications you’re taking, and recent medical visits with other specialists.
Diagnosis
If you’ve been referred for a cancer diagnosis, your medical oncologist will order lab tests, which may include a blood work-up, complete blood count (CBC), urinalysis and other tests. The doctor may order a biopsy of the tumor site. And you’ll have imaging scans as well, such as CT, X-ray, MRI, PET, ultrasound, or bone scan.
After confirming your diagnosis, your medical oncologist will put together your team of treatment specialists — usually a surgeon, medical oncologist, and radiation oncologist. An integrative oncologist is also available to help you with treatment and quality of life issues. Together, your team develops a treatment plan tailored exactly to your lifestyle and treatment goals. If you’ve come to us with a blood disorder or hematologic malignancy, one of our skilled oncologist/hematologists will diagnose the condition, prescribe treatment and establish your follow-up protocol.
Treatment options are varied and you may have surgery, chemotherapy, radiation therapy or a combination of all three. It depends on the type and stage of your cancer. Our certified nursing staff will explain treatment protocols and review any potential side effects. Treatment will take place at one of our clinics or in a hospital.
During and after cancer treatment, you’ll have several follow-up appointments so your treatment team can continue to assess your progress and recovery. They’ll be there to help you with treatment questions, possible side effects and to plan your long-term follow-up care.
El Portal Comprehensive Cancer Center Expert Medical Oncology treatment team will always be here for you.
Once the diagnosis has been made, you will probably talk with your primary care physician along with several cancer specialists, such as a surgeon, a medical oncologist and a radiation oncologist, to discuss your treatment choices. These specialists will work together to help recommend the best treatment for you.
In some cases, your cancer will need to be treated by using more than one type of treatment. For example, if you have breast cancer, you might have surgery to remove the tumor (by a surgeon), then have radiation therapy to destroy any remaining cancer cells in or near your breast (by a radiation oncologist). You also might receive chemotherapy (by a medical oncologist) to destroy cancer cells that have traveled to other parts of the body.
Meeting With a Radiation Oncologist
If you are considering radiation therapy, you must first meet with a radiation oncologist to see if radiation therapy is right for you. During your first visit, your doctor will evaluate your need for radiation therapy and its likely results. This includes reviewing your current medical problems, past medical history, past surgical history, family history, medications, allergies and lifestyle. The doctor will also perform a physical exam to assess the extent of your disease and judge your general physical condition. You may also be seen by a medical student, a resident (radiation oncologist in training), a nurse practitioner, a physician’s assistant or a nurse.
After reviewing your medical tests, including CT scans, MRI scans and PET scans, and completing a thorough examination, your radiation oncologist will discuss with you the potential benefits and risks of radiation therapy and answer your questions.
Simulation
To be most effective, radiation therapy must be aimed precisely at the same target or targets each and every time treatment is given. The process of measuring your body and marking your skin to help your team direct the beams of radiation safely and exactly to their intended locations is called simulation.
During simulation, your radiation oncologist and radiation therapist place you on the simulation machine in the exact position you will be in during the actual treatment. Your radiation therapist, under your doctor’s supervision, then marks the area to be treated directly on your skin or on immobilization devices. Immobilization devices are molds, casts, headrests or other devices that help you remain in the same position during the entire treatment. The radiation therapist marks your skin and/or the immobilization devices either with a bright, temporary paint or a set of small, permanent tattoos.
Your radiation oncologist may request that special blocks or shields be made for you. These blocks or shields are put in the external beam therapy machine before each of your treatments and are used to shape the radiation to your tumor and keep the rays from hitting normal tissue. Multileaf collimators may also be used to shape the beam and achieve safe delivery of your radiation treatment.
Treatment Planning
Once you have finished with the simulation, your radiation oncologist and other members of the treatment team review the information they obtained during simulation along with your previous medical tests to develop a treatment plan. Often, a special treatment planning CT scan is done to help with the simulation and treatment planning. This CT scan is in addition to your diagnostic CT scan. Frequently, sophisticated treatment-planning computer software is used to help design the best possible treatment plan. After reviewing all of this information, your doctor will write a prescription that outlines exactly how much radiation you will receive and to what parts of your body.
When you undergo external beam radiation therapy treatment, each session is painless, just like getting an X-ray. The radiation is directed at your tumor from a machine located away from your body, usually a linear accelerator. External beam radiation is noninvasive, unlike surgery which is an invasive process. One of the benefits of radiation therapy is that it is usually given as a series of outpatient treatments (meaning you don’t have to stay in the hospital). You may not need to miss work or experience the type of recuperation period that may follow other treatments.
Treatments are usually scheduled five days a week, Monday through Friday, and continue for one to 10 weeks. The number of radiation treatments you will need depends on the size, location and type of cancer you have, the intent of the treatment, your general health and other medical treatments you may be receiving.
The radiation therapist will give you your external beam treatment following your radiation oncologist’s instructions. It will take five to 15 minutes for you to be positioned for treatment and for the equipment to be set up. If an immobilization device was made during simulation, it will be used during every treatment to make sure that you are in the exact same position every day.
Once you are positioned correctly, the therapist will leave the room and go into the control room next door to closely monitor you on a television screen while giving the radiation. There is a microphone in the treatment room so you can always talk with the therapist if you have any concerns. The machine can be stopped at any time if you are feeling sick or uncomfortable.
The radiation therapist may move the treatment machine and treatment table to target the radiation beam to the exact area of the tumor. The machine might make noises during treatment that sound like clicking, knocking or whirring, but the radiation therapist is in complete control of the machine at all times.
The radiation therapy team carefully aims the radiation in order to reduce the dose to the normal tissue surrounding the tumor. Still, radiation will affect some healthy cells. Time between daily treatments allows your healthy cells to repair much of the radiation effect, while cancer cells are not as likely to survive the changes.
Sometimes a course of treatment is interrupted for a day or more. This may happen if you develop side effects that require a break in treatment. These missed treatments may be made up by adding treatments at the end. Try to arrive on time and not miss any of your appointments. Time spent in the treatment room may vary depending on the type of radiation, but it generally ranges from 10 to 40 minutes. Most patients are treated on an outpatient basis, and many can continue with normal daily activities.
Your radiation oncologist monitors your daily treatment and may alter your radiation dose based on these observations. Also, your doctor may order blood tests, X-rays and other tests to see how your body is responding to treatment. If the tumor shrinks significantly, another simulation may be required. This allows your radiation oncologist to change the treatment to destroy the rest of the tumor and spare even more normal tissue.
During radiation therapy, your radiation oncologist and nurse will see you regularly to follow your progress, evaluate whether you are having any side effects, recommend treatments for those side effects (such as medication) and address any concerns you may have. As treatment progresses, your doctor may make changes in the schedule or treatment plan depending on your response or reaction to the therapy.
Your radiation therapy team may gather on a regular basis with other healthcare professionals to review your case to ensure your treatment is proceeding as planned. During these sessions, all the members of the team discuss your progress as well as any concerns.
Image-guided radiation therapy (IGRT) is the process of frequent three-dimensional imaging, during a course of radiation treatment, used to direct radiation therapy utilizing the imaging coordinates of the actual radiation treatment plan.
Brachytherapy is the placement of radioactive sources in or just next to a tumor. The word brachytherapy comes from the Greek “brachy” meaning short distance. During brachytherapy, the radioactive sources may be left in place permanently or only temporarily, depending upon your cancer. To position the sources accurately, special catheters or applicators are used.
There are two main types of brachytherapy – intracavitary treatment and interstitial treatment. With intracavitary treatment, the radioactive sources are put into a space near where the tumor is located, such as the cervix, the vagina or the windpipe. With interstitial treatment, the radioactive sources are put directly into the tissues, such as the prostate.
Sometimes these procedures require anesthesia and a brief stay in the hospital. Patients with permanent implants may have a few restrictions at first and then can quickly return to their normal activities. Temporary implants are left inside of your body for several hours or days. While the sources are in place, you will stay in a private room. Doctors, nurses and other medical staff will continue to take care of you, but they will take special precautions to limit their exposure to radiation.
Devices called high-dose-rate remote afterloading machines allow radiation oncologists to complete brachytherapy quickly, in about 10 to 20 minutes. Powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by your radiation oncologist. You may be able to go home shortly after the procedure. Depending on the area treated, you may receive several treatments over a number of days or weeks.
Most patients feel little discomfort during brachytherapy. If the radioactive source is held in place with an applicator, you may feel discomfort from the applicator. There are medications that can relieve this discomfort. If you feel weak or queasy from the anesthesia, your radiation oncologist can give you medication to make you feel better.
Depending on the type of brachytherapy you received, you may need to take some precautions after you leave your treatment, particularly if you plan to be around young children or pregnant women. Ask your radiation oncologist or radiation oncology nurse about anything special you should know.
After treatment is completed, follow-up appointments will be scheduled so that your radiation oncologist can make sure your recovery is proceeding normally and can continue to monitor your health status. Your radiation oncologist may also order additional diagnostic tests. Reports on your treatment may also be sent to the other doctors helping treat your cancer.
As time goes by, the number of times you need to visit your radiation oncologist will decrease. However, you should know that your radiation oncology team will always be available should you need to speak to someone about your treatment.
If needed, a skin biopsy is performed in order to obtain tissue for further examination in the laboratory, typically through microscopy or tissue culture. Because of the relatively low risk of skin biopsy as compared with biopsy of other organs, and the ability to obtain a sample under simple local anesthesia, a skin biopsy can be safely and routinely performed in an outpatient or ambulatory setting in addition to the inpatient setting. The usual intent of skin biopsy is to further characterize the nature of a skin growth or eruption and assist in diagnosis by allowing histopathologic evaluation of a tissue sample.
If you notice any skin changes, always let your doctor and team know about them. Many cancer treatments can cause your skin to change and it’s important to keep your doctor informed of any treatment side effects you may experience.
Be gentle with your skin. Be careful not to scratch, rub or scrub your skin. Wear soft, non-irritating fabrics next to your skin. Avoid using hot or cold packs on treated areas of skin unless your doctor/team says it’s okay. Use alcohol-free, fragrance-free, hypoallergenic moisturizer on your skin.
Drink plenty of fluids. This can help keep your skin hydrated. Avoid caffeine or alcohol.
Keep your skin moist. To reduce skin dryness, shower in lukewarm instead of hot water. Limit showers to one a day. After you shower, put moisturizing lotion on your skin while it’s still damp. Look for a moisturizer that’s alcohol-free, fragrance-free and hypoallergenic. Apply moisturizer to your skin at least twice a day.
Protect your skin from the sun. Some cancer treatments may make your skin more sensitive to the sun. Ask your doctor/team if you should use sunblock every day. To protect your skin when you go outdoors, wear a broad-brimmed hat, long-sleeved shirt and long pants.
Look after your fingernails and toenails. Sometimes, problems with your nails develop weeks or months into your cancer treatment and may continue after you finish treatment. The skin around your fingernails or toenails may become dry, brittle or cracked, and some of your nails may become ingrown. Try not to bite your nails, and avoid using fake nails or wraps. Wear gloves when you wash dishes or do other chores in the house or yard. Moisturize your hands and feet often. Avoid wearing tight-fitting shoes.
Try to prevent pressure sores. If you spend a lot of time lying in bed or sitting in a chair, you may be at risk for pressure sores. Try to avoid lying or sitting in the same position for a long time. Shift your weight or change your position often. Talk to your doctor or team about being physically active, or if you’re unable to walk, move your arms and legs up and down and back and forth.
Tell a doctor or team right away if you feel pain or burning during chemotherapy. Chemotherapy drugs that touch the skin can cause pain or burning. If you feel pain or burning during intravenous (within a vein) treatment, tell a doctor or team right away. Be sure to follow any instructions the doctor or team gives you on how to care for your skin when you are at home.
Cancer doctors usually treat cancer with radiation therapy, surgery or medications, including chemotherapy, hormonal therapy and/or biologic therapy, either alone or in combination. If your cancer can be treated with radiation, you will be referred to a radiation oncologist – a doctor who specializes in treating patients with radiation therapy. Your radiation oncologist will work with your primary doctor and other cancer specialists, such as surgeons and medical oncologists, to oversee your care. He or she will discuss the details of your cancer with you, the role of radiation therapy in your overall treatment plan and what to expect from your treatment.
The information provided on this website is informational only and is not intended to be a substitute for a thorough discussion or diagnosis with your doctor.
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