Radiotherapy uses ionizing radiation to fight cancer cells. This method is often used in thetreatment of rectal cancer. Usually it is combined with chemotherapy - drugs 5-FU and capecitabine. Cytostatics sensitize abnormal cells to radiation exposure.
Assuta Hospital offers services radiotherapy for rectal cancer at the Institute for radiotherapy and radiosurgery at the clinic. The benefits of choosing:
- broad technical capabilities - modern equipment and materials;
- high professional training of doctors and a great experience;
- the least adverse effect on healthy tissue by applying a wide variety of techniques which reduce the potential side effects.
Radiation therapy in rectal cancer
Radiotherapy in this disease is recommended:
- Before surgery.
- After surgery.
- For the treatment of symptoms of metastatic cancer.
Preparation for radiotherapy in rectal cancer
The doctor gives the patient the following information:
- treatment would be an internal or external radiotherapy;
- the purpose of irradiation - curative or palliative;
- required number of sessions;
- advantages and disadvantages of radiotherapy;
- short and long term side effects;
- any risks;
- possible alternative treatments.
It would be useful to write a list of questions and ask a team of doctors in the process of communication.
If the patient - a woman of childbearing age, it is important not to become pregnant during therapy. Irradiation of harm to the fetus.
If the patient has a pacemaker, implantable cardiac devices or cochlear implant, you need to notify the doctor. These devices may be affected by radiation therapy.
External radiotherapy before surgery
Doctors refer to the irradiation of rectal cancer before surgery to reduce the risk of relapse and reduce the amount of tumor, surgery to make it easier to remove it.
If malignancy is operable, it will, most likely, has been appointed a short course of 5 radiotherapy treatments a week before surgery. This will destroy a large number of cancer cells, as well as reduce the likelihood that cancer cells spread. Simultaneously with radiation therapy can be carried outchemotherapy (5-FU or capecitabine) - chemoradiotherapy.
If the tumor is large, you may need a longer course of treatment before surgery - about 5 months. It may be necessary to the simultaneous fulfillment of chemotherapy. The operation was carried out several weeks after exposure, when the tumor is reduced.
Internal radiation therapy for rectal cancer
This type of radiotherapy involves placement of a radioactive source near malignancy within the body - the brachytherapy. There are two types of it: high-and contact.
HDR brachytherapy, which provides radiation directly to the tumor. It is carried out only if the tumor is located in the middle or lower third of the rectum. Typically, prior to surgery. The challenge is to reduce its volume, to facilitate the removal process.
Before the procedure, the patient is given a sedative. The doctor inserts a tube into the rectum, brings close to the tumor. The radiologist takes a picture to make sure the correct location. The tube is attached to the equipment providing brachytherapy. Using the remote control of remote radioactive source is moved through the tube to a predetermined position to provide a correct dose of the tumor irradiation. The procedure lasts 10-15 minutes. The operation was carried out in a few weeks.
According to the study, people who received brachytherapy, rarely need to create a colostomy, than those who received external radiation therapy. Currently there is no information whether radiotherapy improves survival interior.
Contact brachytherapy uses low doses of radiation to fight cancer. This technique is called Papillon. It is recommended only for small tumors less than 3 cm at an early stage where there are contraindications for surgery. Contact brachytherapy can also offer, if the patient refuses surgery and stoma. The procedure is performed on an outpatient basis, it does not require general anesthesia. This technique is only available in some hospitals.
Treatment is preceded by a diet with a low-fiber diet for 3 days. Before the procedure, make an enema, a local anesthetic is applied around the anus. The doctor examines the rectum by a sigmoidoscope. Gently enters the applicator through which the tube is placed, which provides radiation. Connect it to a computer, the procedure lasts about a minute, but generally stay in office will be about an hour.
The next session will be held in two weeks. A number of treatments will depend on the reaction body. If the effect does not follow recommended external radiotherapy with / without chemotherapy. Or it will be offered surgery.
According to the study, the risk of recurrence is slightly higher compared with surgery. Cancer is returned after contact brachytherapy in 10 of 100 (10%), after other methods have 1-4 out of 100 (4.1%).
After contact radiotherapy requires careful observation as possible side effects include:
- Education hole in the rectum or bladder.
- Narrowing (stenosis) of the anus.
- The occurrence of a fistula between the rectum and the bladder or vagina.
Radiation therapy in rectal cancer after surgery
Radiotherapy after surgery can be offered in the following cases:
- The tumor is difficult to remove.
- The surgeon believes that the cancer cells remained.
- Cancer sprouted through the intestinal wall and spread to nearby lymph nodes.
This treatment takes 4 to 5 weeks. Procedures are carried out during the week, it has a total of 20-25 fractions. Radiotherapy in the form of fines reduces undesirable effects on healthy tissue. It may also be recommended chemotherapy concurrently with radiation.
Remote radiotherapy is preceded by careful planning, calculated the amount of radiation exposure and location of colorectal cancer. Planning ensures that the radiation will be directed precisely to the tumor, so that will cause the least damage to the surrounding healthy tissue. Treatment is planned on the basis of individual clinical oncologist, physicist and radiologist. The first meeting usually takes 30-60 minutes. The staff at the Institute of Radiotherapy tell us what to expect and prepare in advance of the patient.
Performed CT scan shows tumor and structure around it. This helps the oncologist and physicist plan the exact area for radiation therapy. During the CT scan creates a three-dimensional picture, the dye is used, it makes more explicit the individual parts of the body if necessary. Instead of CT or MRI is sometimes performed PET.
In order that the patient kept in a fixed position during irradiation of cancer of the rectum may require special tools or masks. Thus, radiation therapy will be the most accurate and efficient. Forms are used to keep the feet or hands, or other body parts in a fixed position. Applied to the skin special tags to mark the place where the radiation will be directed.
During radiotherapy require special skin care in the treatment zone. Doctors will give advice on how to care for the skin. It is generally recommended to avoid using scented soap, lotions in therapy. Some foods can aggravate the pain.
Radiation therapy is carried out in a special compartment in the week. Its duration before surgery - 1-5 weeks, the duration of effect size and type of tumor. If the irradiation is performed after surgery, the course is usually 4-5 weeks, sometimes 6-7.
Radiation therapy for advanced rectal cancer
If there is secondary lesions, radiation therapy will not cure the disease. Its task consists in reducing and slowing tumor growth. Irradiation can relieve symptoms such as pain in the pelvis or rectum or bleeding.
Metastases radiation therapy may include one or more procedures. Faction take a few minutes, you must lie still.
If the cancer has spread to the liver, may be used specialized methods - stereotactic radiation therapy or selective internal radiotherapy.
Possible unwanted effects of radiotherapy for rectal cancer
Irradiation may cause some side effects. These effects usually appear gradually and include the following symptoms.
- Fatigue. During treatment, the patient may find that he became tired more. Most often this symptom noted in the course of radiotherapy, as a result of the treatment itself. It is important to get a rest when needed. Will benefit the execution of simple exercises every day.
- Diarrhea. Doctor may prescribe medications to reduce this symptom. It is necessary to drink plenty of fluids.
- Nausea. The patient will be no appetite and the desire to drink the water, if he feels sick. If you have problems with the food, it is possible to give preference to high-calorie drinks.
- Frequent urination. The rectum is a very close to the bladder. Therefore, radiation therapy for rectal cancer may irritate the mucous membrane of the urinary bladder. Sometimes, a patient there is a condition that is similar to cystitis, a bladder infection. It can also feel the urge, when the body is empty, and a burning sensation during urination. It is important to drink as much liquid as possible. Many people believe that drinking cranberry juice can be helpful in case of problems with the bladder. However, cranberry juice increases the effects of warfarin (an anticoagulant). Therefore, if a person takes warfarin not to drink cranberry juice. After the treatment the inflammation of the bladder pass. If you experience pain you must notify your doctor. This may be a sign of infection and to require treatment with antibiotics.
- inflammation of the skin. Radiotherapy for rectal cancer may cause pain and irritation of the skin around the anus, it is very sensitive. Sometimes redness and pain during radiotherapy. It must be used in the care of plain water, plain soap and a soft cloth. The doctor will give the cream to protect your skin and help it heal faster. Should not use scented or medicinal soap, any lotions, if not previously discussed with a specialist. When the discomfort while sitting, you can use a soft cushion. After treatment, pain will decrease gradually over several weeks.
Long-term adverse effects of radiation therapy for rectal cancer
Radiotherapy is able to trigger long-term side effects in some people more than others. Treatment is carefully planned to reduce the number of possible negative consequences.
Not every patient who passes radiotherapy, such actions occur. In some cases, the condition is normalized soon after treatment. But sometimes short-term symptoms persist and become long-term. It happens that the temporary manifestations go, but develop a long-term disturbances in the intestines or bladder. After completing a course of radiotherapy, they can occur in a few months to up to two years.
The long-term effects of radiation therapy include:
- private chair;
- fecal incontinence;
- poor absorption of nutrients in the intestines, resulting in weight loss.
Radiotherapy can also affect the bladder, causing:
- urinary incontinence;
- loss of elasticity of the bladder wall, leading to frequent urination;
- increased fragility of blood vessels, provoking blood in the urine.
The treatment may affect sex life, causing:
- early menopause;
- difficulties with erections;
- loss of fertility;
- dryness and narrowing of the vagina, leading to painful sex.
It is important to interact with your doctor if you develop any of these side effects. There are ways to mitigate them or control. Sometimes other conditions, such as infection, can lead to symptoms that develop into long-term side effects.
Reviews of radiotherapy for rectal cancer in Assuta very positive, because the treatment meets the highest international standards.
The Institute is headed by a leading radiologist in Israel - Svetlana Zalmanova.
Medical facility equipped with the latest models of linear accelerators, only the best professionals are invited to work in the Assuta.