radiation booklet_final

Radiation Treatment for Cancers of the Blood and Lymph

INTRODUCTION

BEFORE TREATMENT Simulation Simulation Day Positioning Scheduling Radiation Treatment Planning

DURING TREATMENT

First Visit Treatments Radiation Appointment Frequency Weekly Doctor Appointments Daily CT Scans Side Effects Most Common Less Common Gas and Radiation Treatment Foods Which Cause Gas Ways to Reduce Gas

SPECIAL TREATMENTS

Total Body Irradiation Cranio-Spinal Radiation Radiation of the Face (with Electron Radiation) Radiation of the Abdomen

AFTER TREATMENT Follow-up Appointments

RESOURCES

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Contents3

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Acknowledgments

RADIATION ONCOLOGY

Bouthaina Shbib Dabaja, M.D., associate professor

Chelsea Pinnix, M.D., Ph.D., assistant professor

Valerie Reed, M.D., assistant professor

Patricia Horace, clinical nurse

JoAnn Shank, physician assistant

Brandi Baker, radiation therapist

Cara Butler, radiation therapist

Neil Hughes, radiation therapist

Diane Lozano, patient services coordinator

PATIENT EDUCATION

Daphne L. Bottossenior communications specialist

Jane C. Franksenior health education specialist

Lorene Payne, Ed.D.associate director

MEDICAL PHOTOGRAPHY

Chris Matulaphotographer

Special thanks to Leslie Ballas, M.D., assistant professor, for the idea

of this booklet.

Thank you to the following people for assisting with the creation of this booklet.

Introduction1st TABAcknowledgments

1INTRODUCTION

This booklet describes what radiation treatment is, how it works against the cancer and other general information like what to expect before, during and after radiation treatment. Your doctor, nurse or health care team member is happy to answer questions.

Radiation is used to treat cancers of the blood and lymph. Radiation uses energy beams directed at the cancer to kill the cancer cells. Ask your nurse for a copy of Radiation Treatment: Questions and Answers available in Patient Education Online, or in myMDAnderson.

The figure below shows lymph nodes (Figure 1). Ask your nurse or doctor to mark the areas where you will receive radiation treatment.

Lymph Node Regions in the BodyThe lymph node (LN) regions that will receive radiation during your treatment are:

Spleen,

Inguinal LN,

Supraclavicular LN,

in the abdominal area

in the groin

above the collarbone

Cervical LN,

Mediastinal LN,

Axillary LN,

in the neck

in the middle of the chest

in the armpit

Infraclavicular LN,

Para-aortic LN,

Pelvic LN,

below the collarbone

in the abdominal area

in the pelvis

Figure 1

Before Treatment2nd TAB

SimulationBefore you have treatment, your health care team will plan your radiation. This involves visits, measurements of your body and the cancer location, and calculations to specifically target the tumor. This is known as simulation. Your treatment depends on accurate simulation. Simulation takes about an hour or two, depending on your cancer and your body.

Wear comfortable clothes. Do not wear earrings or necklaces. You will lie in one position for a while, so take your pain medicine one hour before your appointment. Your doctor can give you medicine to calm you. Ask for this before simulation if you think you will need it.

Simulation DayWhen you arrive for your appointment, sign in at the front desk.

In the simulation area, the radiation therapist will take a photograph of your face. This picture will be used to identify you throughout your treatment and is a standard safety measure. The therapist will explain the simulation to you. Your doctor will review the procedure with you. You will then sign a consent form.

You will undress and change into a hospital gown. The therapist will then help you lie on a table (Photo 1).

Although the simulation table will have a sheet on it, the table is hard and has no cushion. The temperature in the room is usually cool. Tell a therapist if you become uncomfortable at any time during the procedure. Throughout the simulation you will feel the table move to different positions. The lights in the room will be turned on and off and you will see red laser lights on each wall. Do not look directly into the red beam as this may hurt your eyes. The therapists use these laser lights as a guide when they position you on the table (Photo 2).

Although the therapists will walk in and out of the room during the procedure, there will always be someone who can see and hear you. You will hear therapists speaking to each other as they work. They will explain what they are doing, but please do not speak once they begin, as this may cause you to move on the table. Of course, let them know if you are uncomfortable or need help. To help pass the time, music can be played throughout the procedure. We have music to choose from, or you can bring your own.

3BEFORE TREATMENT

Photo 2

Photo 1

PositioningThroughout the simulation, you will lie on a table while the therapists and your doctor determine what position you will be in. The exact position and treatment accessories depends on where you need radiation. These positions and accessories are briefly described on the next few pages. If you have questions, ask your nurse for more information.

Skin Markings (Tattoos)If the location of your cancer requires skin markings, therapists will draw on your skin with a felt marker. This creates a temporary skin marking. If permanent markings are required (tattoo), a sterile needle and a drop of ink will be used. The tattoo marks are no bigger than the head of a pin. They will be placed in the areas to be treated. After the markings are made, the therapist will take several photographs of you in the simulation position. Tattoo marks are used as guides to position you correctly on the table each day for treatment. The felt markings can be washed off after simulation, but permanent tattoos will not wash off.

MaskRadiation to the head requires making a mask (Figure 2). While you are lying on the table, the therapist(s) will place a warm, wet sheet of plastic mesh over your face and will shape it to fit around your head and shoulders. You will be able to breathe and hear while the mask is on. As the mask cools it will harden and you will feel some pressure as the therapist fits the mask to your face. This takes about 15 minutes.

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Figure 2

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Breath-Hold TechniqueIf the cancer is near important organs (such as the heart or kidneys), your team will show you how to do the breath-hold technique. You will lie on a table with a camera above you and another at the side (Photo 3). Sensors will be placed on your abdomen signaling an infrared camera at the edge of the table. The therapist will give you further instructions. You will perform the breath-hold technique several times during the planning process and every day during your treatment.

Photo 3

Positioning continued...

Vac-LockSome patients need a special body mold (called a Vac-Lock) made to keep them steady. This is a plastic or plaster form that helps make sure you are in the exact position for each treatment. You will lie on top of the Vac-Lock on your back or abdomen, with your arms raised above your head or by your side (Photo 4). The bag has beads in it that will harden as the air gets sucked out of it. This takes about 15 minutes.

Photo 4

While wearing the special goggles, you’ll be able to see a blue and yellow bar in the distance. As you hold your breath, this yellow bar will move into

the blue bar, forming a green and blue line. When it is time, your nurse will tell

you to relax and breathe normally.

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SchedulingAfter simulation is done, your treatment will be planned and scheduled.

Radiation Treatment PlanningYour radiation oncologist (doctor) will work with a team to plan your treatment. They will use your simulation CT scan to plan the angles and shapes of the radiation beams. The team will also compute the exact radiation dose. The details are carefully planned and checked. This takes a few working days depending on your case.

Positioning continued...

Photo 5

Chest ProtectionWhen treating the chest area in females younger than 35 years of age, and to decrease the risk of breast cancer, a special board (Photo 5) will be used to move the breasts as far away as possible from the radiation field. If you have questions during any of these processes, your therapist can hear you at all times. When you are in the final position during simulation, a computerized tomography (CT) scan will be taken. Repeated CT scans may be needed during treatment. Whenever you get a CT it is important to follow the therapists’ instructions on breathing.

During Treatment3rd TAB

First VisitWhen you come for your first treatment, check in at the receptionist desk. The staff will sign you in on the computer and send a message to the radiation therapists, letting them know that you have arrived.

Once you are in the treatment area, you will be taken to a dressing room and asked to change into a gown. The therapists will bring you to a room where you will receive your treatment each day.

They will position you on the table exactly as you were the day of your simulation. X-rays of each of the radiation beams will be taken to make sure that your position on the table is correct and that the area being treated is exactly what your radiation doctor wants. The films will be repeated throughout your treatment; this will follow a schedule determined by your doctor. Films taken during treatment are used to make sure you are in the right position and are getting treatment in the right place. They are not used to see how your tumor is responding to treatment. Once this verification is done and approved by your doctor, the therapist will deliver the first treatment. Verification takes about an hour.

TreatmentsYou will not see or feel the radiation. You may hear the machine as it moves around you and is turned on and off. You will be in the treatment room from 10 to 40 minutes depending on the complexity of your treatment. Most of the time will be spent positioning you correctly. The actual treatment only takes a few minutes.

Although you are alone during the treatment, the therapists can see you on a monitor and hear you through an intercom at all times (Photo 6). Breathe normally during the treatment, but do not move. If you are very uncomfortable, ask the therapists for help. They can turn off the machine and come in to see you at any time.

Radiation Appointment FrequencyRadiation treatments are given daily, Monday through Friday. You must come in every day for your treatment. Treatment may not be as effective if you skip or miss treatment days. If you need to change your schedule, please talk with your radiation therapist.

Weekly Doctor AppointmentsYour radiation doctor oversees the entire treatment. You will see your doctor and nurse each week to check for side effects. The visit will be before or after the treatment and will take about one extra hour that day. This visit is a good time to ask questions and discuss any concerns you have. If you need to speak with your doctor or nurse any time between weekly visits, this can be arranged.

Daily CT ScansSome treatments require a daily CT scan to ensure that we are treating the correct area in situations when tumors might move from day to day.

7DURING TREATMENT

Photo 6

8Side Effects Some people develop side effects from treatment. The type, and how severe they are, depend on many factors. These include the dose of radiation, the number of treatments, the area treated, and your general health. Side effects may be worse if you are also having chemotherapy.

Most CommonBelow are the most common side effects of radiation. You may have all, some or none of these side effects.

Skin ReactionsYou will notice changes in the skin and hair in the area being treated. This is normal. After two or three weeks, your skin will become pink or tanned. As treatment continues, it may become bright red or very dark. Your skin may also feel dry and itchy, and it may look flaky. You may notice a rash, especially in any area where you have had previous sun exposure. Although this may be a side effect of treatment, a rash could be a sign of infection. If you develop a rash at any time during your treatment, tell your doctor or nurse.

Sometimes the skin in sensitive areas, such as earlobes, armpits or near the collarbone, may blister, open and peel. If this occurs, tell your doctor or nurse. The skin reaction sometimes becomes more severe during the week after treatment is done. If this happens, call your doctor or nurse. The skin reaction will gradually heal, but this often takes three or four weeks.

You may lose some or all of the hair in the area being treated. The hair will usually begin to grow back two to four months after treatment is completed. It will grow back completely within six to 12 months.

Below are guidelines to help you care for your skin. Continue these until the skin reaction resolves. These refer to the skin only in the area being treated.

When washing, be gentle in the area being treated. Do not use a washcloth, sponge or brush. Bathe or shower daily, using warm water and a mild unscented soap. Examples of soaps you may use include: Dove®, Basis® and Cetaphil®. Rinse the skin well and pat dry with a soft towel.

The tattoo marks are permanent and will not wash off. You may get other markings during treatment. For example, the therapist may use a felt-tipped marker to outline your treatment area. Use mineral oil to remove these lines when the therapists tell you they can be washed off. Do not use alcohol or alcohol pads on treated skin areas.

Moisturize skin with Aquaphor®, Eucerin®, a pure aloe vera gel, or as recommended by your nurse. Use only one product at a time unless your nurse tells you to use more. Using aloe vera directly from the plant is more likely to cause allergic reactions than using a pure aloe vera gel. We recommend that you do not use the plant version.

Apply moisturizers two times a day. Your nurse will tell you if you need to do it more or less often.

If you are treated in the morning, apply moisturizer after your treatment and before you go to bed.

If you are being treated in the afternoon, apply it in the morning at least four hours before your treatment and before you go to bed.

9Skin Reactions continued...

FatigueMost people develop fatigue after two or three weeks of treatment. People commonly describe their fatigue as: tiredness, weariness, lack of energy, weakness, and being unable to concentrate. These symptoms gradually go away after your treatment is done, but may last several months. Chemotherapy may worsen fatigue.

Below are suggestions to help manage fatigue:

Emotional ConcernsHaving cancer is likely to cause you and the people who care about you to react in many ways. You may feel anxious, nervous, depressed, alone, angry or other emotions. These feelings are normal and expected if you or someone you love has a serious illness. Each person deals with emotional concerns in their own way.

MD Anderson has many resources for helping you handle these challenges. See Resources on page 13, at the end of this booklet, for more information.

Do not use deodorants, make-up, and/or perfumes or powders in the area being treated.

Do not shave the treated skin. If you must shave, use only an electric razor. Stop if the skin becomes irritated.

If your skin is itchy, don’t scratch it. Your nurse will recommend ways to relieve the itch.

Do not use any tape on treated skin.

Avoid chlorinated water (swimming pool, spa, hot tub) if you have a skin reaction. If you have no skin reaction, rinse off immediately after you leave the pool.

Avoid applying extreme heat or cold to the treated skin. This includes hot tubs, water bottles, heating pads and ice packs.

Avoid tanning or burning your skin during treatment and for the rest of your life. If you are going to be in the sun, use a PABA-free sunblock with an SPF of 30 or higher. Wear clothing that covers you as much as possible.

Keep working during treatment if possible. You may find that working shorter hours will help you feel less tired.

Plan your daily activities for times you have most energy.

Ask family and friends to help you with things such as shopping, cooking and cleaning.

Plan rest time or take naps for short periods during the day. You may also find it helpful to go to sleep earlier and get up later in the morning.

Exercise increases energy level. Ask your doctor if you can do light exercise, such as walking.

Eat foods high in protein and calories.

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Less CommonSome people have other side effects. These are associated with the specific area of the body being treated.

Bone Marrow SupressionBone marrow is the substance inside bone that produces blood cells. Your blood cell counts may go down. This makes it harder for the body to fight infection. Call your doctor or nurse immediately if you develop: a fever of 100.5°F (38°C) or greater, shaking, chills, or flu-like symptoms. You may also bleed more easily, so call if you develop bleeding gums, or blood in the urine or stool.

Mouth ChangesIf your mouth is in the radiation treatment area, you may notice some changes. These are expected, although each person reacts differently. After two weeks, the membranes lining your mouth and throat may begin to feel tender, and you may feel a burning sensation or be more sensitive to hot and spicy foods. You may also feel discomfort when you swallow. Your mouth will gradually heal after treatment is completed, but this may take four weeks.

If your salivary glands are in the treatment area, your mouth will get dry. You must see a dentist before you begin treatment. Tell your dentist that you are going to have radiation, and ask for a fluoride toothpaste. Have any dental care done before treatment begins.

You must take special care of your mouth. Below are guidelines to help ease any mouth changes you may experience due to the side effects of radiation therapy.

Side Effects continued...

Brush your teeth after eating and at bedtime with a toothpaste that contains fluoride (such as Biotene ). Use a soft-bristle toothbrush.

If you have dentures, remove and clean them each time you clean your mouth.

If you currently floss your teeth, continue to floss unless or until your gums become tender or bleed. If you have not flossed in the past, do not begin now.

Do not use commercial mouthwashes that contain alcohol. Alcohol will sting and irritate your mouth.

Use one of the following solutions to rinse your mouth out four to six times each day. Swish for one minute, gargle, then spit.

Tell your doctor or nurse if you have pain or difficulty swallowing. Sucking on throat lozenges will often help. We can also prescribe medicine to make you more comfortable.

one quart water or normal saline mixed with one teaspoon baking soda (sodium bicarbonate);

one quart water mixed with one teaspoon salt or one teaspoon baking soda (sodium bicarbonate); water; or non-alcoholic unsweetened mouthwash (such as Biotene mouthwash).®

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Dry Mouth During and After TreatmentIf you have dry mouth during or after treatment:

Mouth Pain or Difficulty SwallowingIf you have pain in your mouth or throat or are having difficulty swallowing:

Mouth Changes continued...

Loss of AppetiteSome people find they are not as hungry during treatment, or lose their interest in food. Your body needs protein and calories to repair the healthy cells injured from radiation. Try not to lose weight during your treatment. Also, if you have a mold to position you for treatment, it may not fit correctly if your weight changes. Below are suggestions to help you maintain your weight and get the food your body needs.

Avoid things that may irritate your mouth and throat, like:

very hot foods and fluids; dry, hard and coarse foods (chips, pretzels, crackers, raw vegetables); spices (pepper, chili, horse radish, Tabasco sauce, curry); acidic or citrus foods and juices (orange, grapefruit, lemon, lime, pineapple, tomato); alcohol or tobacco.

Apply beeswax or a moisturizer, like Aquaphor , to your lips four to six times a day. Do not apply it within four hours of your radiation treatment.

Sip water or other liquids throughout the day. You may find it helpful to carry a thermos or water bottle.

Use artificial saliva (mouth moisturizer)

Use a humidifier at home, especially at night. Be sure to change the water and clean it as directed.

Use a spray bottle to moisten your mouth with water.

Rinse your mouth to provide moisture before eating.

Use sauces and gravy to soften food.

Eat soft, moist, bland foods taken in small bites and chew well.

Drink liquid nutritional supplements.

Try blenderized or pureed foods.

If you are not sure what to eat, ask to see a dietitian.

Eat your meals in a calm place and take your time. Eat with family or friends whenever possible.

Eat small meals often throughout the day. If you never seem to feel hungry, set up a schedule to ensure you eat regularly, for example every two hours.

Vary the color and texture of foods to make them more appealing.

Bring snacks and drinks with you when you come for treatment.

Nutrition drinks are a good choice for extra protein and calories. There are many products available. Ask your doctor or nurse which product is best for you.

You may take a daily multivitamin if you wish. Do not take more than the recommended daily allowance of any vitamin. This includes both nutritional and herbal supplements. Tell your doctor about all medicines and supplements you take.

Choose foods high in calories and protein, and eat a variety of foods.

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12Less Common Side Effects continued...

HeartburnIf the esophagus is in the treated area, some people get heartburn in the second or third week of treatment. The heartburn can last two weeks after treatment is done.

Follow the suggestions below to minimize discomfort.

NauseaSome people have nausea, with or without vomiting. This may happen as early as the first treatment. If you have nausea or vomiting, tell your doctor or nurse. Medicine can be prescribed to relieve this. Below are suggestions to help reduce nausea.

Try freezing your favorite beverages in ice cube trays and sucking on these during the day.

Have small frequent meals through the day. Some people find ginger tea helpful if no mouth sores.

Keep food at room temperature or cooler.

Foods that are usually well tolerated include:

Drink only small amounts of liquids with meals to prevent feeling full or bloated.

Eat a light meal before radiation treatment.

Avoid foods and liquids that may worsen nausea, like:

Hot foods with strong odors; spicy, fatty, greasy and fried foods; very sweet foods; acidic or citrus foods and juices (orange, grapefruit, pineapple, tomato); and alcohol.

Toast, soda crackers, melba toast, dry cereal, pretzels and angel food cake; yogurt, sherbet, and clear liquids (apple juice, Jell-O , ginger ale); cold chicken or turkey, baked or broiled, with the skin removed; and soft fruits and vegetables.

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Take small bites of food and chew well before you swallow. Use sauces and gravy to soften foods. Or, try blended or pureed foods.

Drink liquid nutritional supplements.

Cold foods and liquids are helpful. Some people find that fruit nectars are especially soothing.

If you are having trouble swallowing pills, ask your doctor or nurse if the medicine comes in liquid form. If not, many pills can be crushed and taken with applesauce. However, check with your doctor, nurse or pharmacist. Crushing some medicines affects their action.

Avoid the items below, as they may irritate the throat and esophagus:

Very hot foods and fluids; dry, hard and coarse foods (chips, pretzels, crackers); spices (pepper, chili, Tabasco sauce, curry); acidic or citrus foods and juices (orange, grapefruit, pineapple, tomato); food or drinks with caffeine (coffee, tea, cola, chocolate); alcohol and tobacco.

Do not eat at bedtime. Sit upright for at least 30 minutes after each meal. This helps prevent stomach juices from flowing back into your esophagus.

Medicine may and can be prescribed to make you more comfortable. Just ask your doctor.

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13Less Common Side Effects continued...

CoughSome people develop a dry cough because the radiation irritates the lining of the lungs.

Do not smoke during your treatment. Smoking will irritate the lining of your airway and cause more coughing. If you would like help to stop smoking, your nurse can refer you to a smoking cessation program.

Sexual IssuesYou do not need to avoid close contact with other people. There is nothing radioactive inside your body. Sexual activity is permitted during treatment, unless your doctor gives you specific instructions. However, if you are in the childbearing years, you must use contraception to prevent pregnancy.

If the treatment area includes sexual organs, speak to your doctor before treatment begins about options for future pregnancy.

See Resources on page 9, at the end of this booklet, for more information.

DiarrheaIf you receive radiation to the abdomen and pelvic area, your bowel movements may change. This can begin the first few weeks after treatment starts. You may have more bowel movements and softer stools. Some people develop diarrhea (increased watery stools).

Below are guidelines to help manage these problems during treatment. Start these if you have symptoms and continue until bowel movements return to their usual pattern. This may take two to four weeks after your treatment is done.

Eat bananas, cantaloupe and potatoes, to help replace potassium that is lost with diarrhea. Ask the dietitian for other food sources of potassium.

®Take medicine for diarrhea. You can buy Imodium without a prescription. Your doctor may prescribe other medicines.

Follow a diet low in fiber, fat and lactose. Ask your nurse for information about this diet. Continue the diet until bowel movements return to their usual pattern. This may take several weeks after your treatment is completed. You can then slowly begin eating foods from your usual diet.

Drink more fluids to replace some of the water and salts you lose in the stool. If your urine is dark, your body needs more liquid. Drink enough fluids to keep your urine light colored or clear. Good choices are water, Gatorade , non-fat soup broth, Pedialyte and juices and nectars. Limit fluids with caffeine (coffee, tea, colas) as they can dehydrate you.

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14Gas and Radiation TreatmentIf you have gas and are bloated in your abdominal and pelvic area, your radiation skin markings may move out of the correct treatment position. Changes in your diet may help reduce gas.

Foods Which Cause GasMost foods that contain carbohydrates can cause gas. In contrast, fats and proteins cause little gas. Foods that produce gas in one person may not cause gas in someone else. This depends on how well an individual digests carbohydrates and the type of bacteria present in the intestines.

Below are types of foods that may cause gas:

Fruits such as pears, apples and peaches

Whole grains such as whole wheat and bran

Sodas

Fruit drinks, especially apple juice and pear juice; and other drinks that contain high-fructose corn syrup which is sweetener made from corn

Vegetables such as broccoli, cauliflower, cabbage, brussel sprouts, onions, mushrooms, artichokes and asparagus

Beans

Milk and milk products such as cheese, ice cream and yogurt

Packaged foods, such as bread, cereal and salad dressing that contain small amounts of lactose, a sugar found in milk and foods made with milk

Sugar-free candies and gums that contain sugar alcohols such as sorbitol, mannitol and xylitol

Ways to Reduce Gas

Reduce Swallowed Air: Swallowing less air may help reduce gas, especially for people who burp frequently. It is also helpful to eat more slowly, avoid gum and hard candies and check with a dentist to make sure dentures fit correctly.

Keep a Diary: Writing down the foods that you eat and symptoms you have after eating can help identify the foods that cause gas. Avoiding or eating less of these foods may help reduce gas symptoms.

Make Dietary Changes: You may be able to reduce gas by eating less of the foods that cause gas. However, many healthy foods may cause gas, such as fruits and vegetables, whole grains and milk products. The amount of gas caused by certain foods varies from person to person. Effective dietary changes depend on learning through trial and error which foods cause gas and how much of the offending foods you can tolerate.

Limit Some Foods: While fat does not cause gas, limiting high-fat foods can help reduce bloating and discomfort. Less fat in the diet helps the stomach empty faster, allowing gases to move more quickly into the small intestine.

Low-Fiber Diet: Your doctor may recommend that you follow a low-fiber diet. This diet can reduce gas by limiting the amount of fresh fruit and vegetables, beans and some dairy products you eat. The clinical dietitian can give you suggestions on which low-fiber foods are best for you.

Directions for Simulation Take two tablets 48 hours before your simulation, including breakfast before the simulation. It is important to take Beano with the first bite of food.

Directions for Daily Treatments Take two tablets with each meal before daily treatment. For example, if your radiation is in the morning, take Beano with breakfast. If your radiation is in the afternoon, take Beano at brea fast and at lunch before treatment.

Take Over-the-Counter Medicine: The medicines listed below, can help reduce gas or the symptoms caused by gas, and are available at pharmacies, drug stores and grocery stores.

Ways to Reduce Gas continued...

Beano (alpha-galactosidase) This medicine contains the digesting enzyme that the body lacks to digest the sugar in beans and many vegetables. However, it has no effect on gas that may be caused by lactose or fiber. This product comes in different forms. Follow the directions on the label. It is important to take this medicine just before eating to help break down the gas-producing sugars in food. Less expensive store brands may work equally as well.

Gas-X , Mylanta Gas (simethicone) This medicine can relieve bloating and abdominal pain or discomfort caused by gas. Follow the directions on the label. Less expensive store brands may work equally as well.

Lactase Tablets or Drops This medicine can help people with lactose intolerance, digest milk and milk products to reduce gas. Lactase tablets are taken just before eating foods that contain lactose; lactase drops can be added to liquid milk products. Lactose-free and lactose-reduced milk and milk products are available at most grocery stores.

If you have questions about your diet, talk with the clinical dietitian during your clinic visit.

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Special Treatments4th TAB

SPECIAL TREATMENT AREAS

Total Body IrradiationThis is a special treatment given to patients with leukemia before a bone marrow transplant. Radiation is delivered to the whole body and patients are usually treated for four days, or are scheduled for once-a-day treatment. The type of transplant regimen you will have will determine the schedule and the number of days needed for treatment. Prior to treatment, the radiation oncologist will take measurements of your body. These measurements are used to calculate the dose of radiation to be delivered. On the day of the assigned treatment, you will be taken from the inpatient floor to the radiation suite. You will be asked to lie down on your side on a special bed (Figure 3). The treatment machine will be approximately 20 feet away from you and the radiation will be delivered in two positions. One position faces the machine and the second position your back will be towards the machine.

Figure 3

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Figure 4

Cranio-Spinal RadiationThis is a special treatment technique to treat the brain and spine (Figure 4). This prevents or treats cancer of the central nervous system (CNS). On the first day of treatment, the set up will be verified using x-rays, which takes some time. The treatment delivery itself takes about one hour. During this time, you will be asked not to move.

Special Treatment Areas continued...18

Special Treatment Areas continued...19

Radiation of the Face (with Electron Radiation)Radiation given to the face is done most of the time using electron radiation. Electron radiation allows safe treatment to the skin and/or eyes. A custom wax mold will be made of your face (Photo 7). This will be used to create special lead shields to protect areas we do not want to treat.

Photo 7

Radiation of the AbdomenIf the abdomen is being treated, you will be asked not to eat or drink six hours prior to the planning and daily treatment time. Some food and fluids can cause gas and potentially change the shape and positions of the bowels and stomach. It is important to avoid these during your full period of treatment. You will receive a list of the foods and fluids to avoid at the time of your consultation. A special machine is designed for the purpose of performing a daily CT scan prior to each treatment (Figure 5). This machine has two heads; one side is a treatment machine and the other is a CT scan machine. Your doctor will check and approve the daily CT scans and give the order to begin treatment.

20Special Treatment Areas continued...

Figure 5

After Treatment5th TAB

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Follow-up AppointmentsIt is very important that you keep follow-up appointments. These visits will help us evaluate your response to treatment. You may have blood tests, X-rays and scans during these visits. Before coming, write down your questions. Bring your questions and a list of all your medicines, supplements and over-the-counter drugs. If you are running low on any medicine, tell your doctor before you run out. Contact your doctor or nurse if you have questions or develop any problems.

AFTER TREATMENT

“Life has two rules: #1 - Never quit,#2 - Always remember rule #1.”

-unknown

Resources6th TAB

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MD ANDERSON RESOURCES

Anderson NetworkThe Anderson Network is a unique cancer support group of current and former patients who know what it’s like to have cancer. The network offers patient-to-patient advice and encouragement. They match the patient with a member who has had the same diagnosis – someone who understands your concerns. For more information, call 800-345-6324.

Integrative Medicine CenterThe Integrative Medicine Center aims to enhance cancer care and quality of life. Programs are open to anyone touched by cancer, their family members and caregivers. You are welcome even if you are not an MD Anderson patient. Approaches focus on the mind, body and spirit. Services include: receiving health advice on how to pursue an integrative approach to cancer care; free group programs discussing diet, meditation, yoga, music therapy and more; massages and acupuncture (for a nominal fee). For more information, call 713-794-4700.

The Learning CenterThe Learning Center is a consumer health library with the latest information on cancer care, treatment, prevention and general health and wellness issues. There are three locations:

RESOURCES

Theodore N. Law Learning Center, Main Building, Floor 4, near Elevator B; 713-745-8063Levit Family Learning Center, Mays Clinic, Floor 2, near The Tree Sculpture; 713-563-8010Holden Foundation Learning Center, Jesse H. Jones Rotary House International, Floor 1; 713-745-0007

EXTERNAL RESOURCES

American Cancer SocietyThis national organization offers a variety of services to patients and their families. The American Cancer Society also supports research, provides printed materials and conducts educational programs. For more information, call 800-227-2345 or visit their website at http://www.cancer.org.

Leukemia and Lymphoma Society The Leukemia & Lymphoma Society (LLS) is the world’s largest non-profit health organization dedicated to funding blood cancer research and providing education and patient services. The LLS provides disease information about leukemia, lymphoma, myeloma and other blood cancers. Support is available for patients and caregivers, guidance in finances and free educational brochures. For more information, call 800-955-4572 or visit their website at http://lls.org.

Lymphoma Research FoundationThe Lymphoma Research Foundation (LRF) is the nation’s largest non-profit organization dedicated to funding new lymphoma research. The LRF provides people with lymphoma and healthcare professionals with up-to-date information about this type of cancer. LRF’s mission is to eradicate lymphoma and serve those touched by the disease. For more information, call 800-500-9976 or visit their website at http://lymphoma.org.

National Cancer InstituteThe NCI is the Federal Government’s principal agency for cancer research and training. For more information about cancer and radiation treatment, call the National Cancer Institute. A trained cancer information specialist will answer your questions. Ask for the booklet “Radiation Therapy and You.” For more information, call 800-422-6237 or visit their website at http://cancer.gov.

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BOOKS

100 Questions and Answers About Lymphoma Peter Holman, M.D., 2011

Meeting the Challenges of Oral and Head and Neck CancerNancy E. Leupold, 2011

Patient’s Guide to Lymphoma Aditya Bardia, M.D. and Eric Seifter, M.D., 2011

Easy-to-Swallow, Easy-to-Chew Cookbook Donna L. Weinhofen, 2002

I-Can’t-Chew-CookbookJ. Randy Wilson, 2003

The Lahey Clinic Guide to Cooking Through CancerLahey Clinic Sophia Gordon Cancer Center, 2012

Nutrition and Cancer: Practical Tips and Tasty Recipes for SurvivorsSandra L. Luthringer, RD, LDN and Valerie J. Kogut, RD, LDN, 2011

Understanding Hodgkin Lymphoma: A Guide for Patients, Survivors and Loved Ones Lymphoma Research Foundation, 2012

Understanding Non-Hodgkin Lymphoma: A Guide for Patients, Survivors and Loved OnesLymphoma Research Foundation, 2012

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CONTACTS

Below are important telephone numbers.

If you have questions about your care, feel free to call any of the following clinical staff listed below. If you leave a message and do not get a call back within 24 hours, please contact your radiation oncologist directly.

For medical emergencies, after 5 p.m., and on weekends and holidays, please call 911 or go to the nearest hospital emergency center.

Patient Service Coordinator (PSC)

Clinic Nurse

Radiation Oncologist

Name:

Phone:

Email:

Name:

Phone:

Email:

Name:

Phone:

Email:

Name:

Phone:

Email:

Name:

Phone:

Email:

Name:

Phone:

Email:

RESOURCES continued...

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Notes

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Notes

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Documents