Esophageal Cancer: Radiation Therapy

What is radiation therapy?

Radiation therapy uses high-energy beams of X-rays or other particles to kill cancer cells or stop them from growing.

When might radiation therapy be used?

Radiation is often part of the treatment for esophageal cancer. Your healthcare provider may suggest this treatment for several reasons:

  • As part of the main treatment for esophageal cancer. It can be used along with chemotherapy (chemo) when surgery can't be done.

  • To try to shrink cancer before surgery. Radiation plus chemo may help shrink a tumor and make it easier to remove. This might reduce the amount of surgery needed.

  • To try to kill any cancer cells left after surgery. Radiation can be used after surgery to kill any cancer cells that may have not been removed. 

  • To ease symptoms such as pain or swallowing problems caused by tumors that can't be treated with surgery or that have spread to other organs.

To plan your treatment, you'll meet with a team of cancer specialists. This might include a surgeon, radiation oncologist, and medical oncologist.

What happens during radiation therapy

A healthcare provider who specializes in treating cancer with radiation is called a radiation oncologist. This healthcare provider works with you to decide the kind of radiation you need. He or she also determines the dose and how long you need treatment.

Two types of radiation can be used to treat esophageal cancer. These are external and internal radiation.

External beam radiation

The most common way to get radiation for esophageal cancer is from a large machine that focuses beams of radiation at the cancer. This is called external beam radiation. Sometimes special types of external beam radiation, such as intensity-modulated radiation therapy (IMRT), are used. This is done to try to limit the amount of radiation that reaches and damages nearby normal cells.

You often get external beam radiation on an outpatient basis in a hospital or clinic. This means you go home the same day.. External beam radiation is usually given 5 days a week for many weeks.

Getting ready for radiation

Before your first radiation treatment, you’ll have an appointment called simulation. This is needed to find exactly where on your body the radiation beam needs to be directed. It may take up to 2 hours. During this session, imaging tests such as CT or MRI scans may be done. These tests help your healthcare providers know the exact location of the tumor so they can aim the radiation right at it. Also at this session, you may have body molds made to put you in the exact same position and help keep you from moving during treatments. Then, you’ll lie still on a table while a radiation therapist uses a machine to define your treatment field. The field is the exact area on your body where the radiation will be aimed. Sometimes it’s called your port. The therapist may mark your skin with tiny dots of semi-permanent ink or tattoos. This is so the radiation will be aimed at the exact same place each time. 

On the days you get radiation

On the days you get treatment, you’ll lie on a table while the machine is placed over you. You may have to wear a hospital gown. It’s a lot like getting an X-ray, but takes longer, up to 15 to 30 minutes. You should plan on being there for about an hour total.

At the start of the treatment session, a radiation therapist helps you get into position and may use blocks or special shields to protect parts of your body from exposure to radiation. The therapist then lines up lights on the machine with the marks on your skin so the radiation is directed to the right spot. When you’re ready, the therapist leaves the room and turns the machine on. You may hear whirring or clicking noises as the machine moves during radiation. This may sound like a vacuum cleaner. The machine won't touch you. During the session, you’ll be able to talk to and hear the therapist over an intercom. You can’t feel radiation, so the process will be painless. You will not be radioactive afterward.

Internal radiation (brachytherapy)

In this approach, a long, thin tube is passed down your throat to put a tiny radiation source right next to the cancer. The radiation travels only a short distance. So, it only affects the cells close to it. Because the radiation travels only a short distance, it can't be used to treat large tumors. This kind of radiation is mainly used to help relieve symptoms, such as to shrink a tumor that's making it hard to swallow.

Getting ready for radiation

To get ready for your treatment, you’ll have an appointment for some imaging tests. These may include a CT scan and esophageal ultrasound. This helps your healthcare provider see your esophagus and the nearby tissues so he or she can map out exactly where the radiation needs to be placed.

On the days you get radiation

You can get this treatment in either a hospital or outpatient setting. On the day of the procedure, you may get a local anesthetic to numb the area or general anesthesia so you fall asleep and don’t feel pain. While you lie on your back, your healthcare provider puts a tube down your throat and into your esophagus. The radiation source is then guided down the tube to the cancer.

The treatment may be given over a few minutes, and may be repeated for a few days. Or the radiation may be left in place for a day or so. In this case, you’ll need to stay in the hospital.

What to expect after radiation therapy

Because radiation affects normal cells as well as cancer cells, you may have some side effects. The side effects from radiation are normally limited to the area being treated. Some people have few or no side effects. If you do have them, your healthcare provider may change the dose of your radiation or how often you get treatment. Or treatment may be stopped until your side effects clear up. Tell your healthcare provider about any side effects you have right away. It's important to treat them before they get worse.

Possible side effects

Common side effects can include:

  • Skin irritation, peeling, or blisters in the areas of your skin that get radiation

  • Fatigue

  • Mouth or throat sores

  • Burning, tightness, or pain when swallowing and eating

  • Dry mouth and throat, or thick saliva

  • Nausea or vomiting

  • Trouble breathing

Most side effects tend to go away over time after you stop treatment. Still, if you have any of these side effects, talk with your healthcare provider about how to deal with them. You should also ask what side effects you might expect and what to do if they become serious. Make sure you know what number to call with questions or problems. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. A written list will make it easier to remember your questions when you go to appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage side effects.

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