Rays of hope

With high rate of early stage cure, radiotherapy has redefined cancer treatment


The number of cancer deaths in India is estimated to reach 13 million by 2030. This is owing to demographic transitions and risk factors such as sedentary lifestyle, genetics, dietary changes and environmental changes.

As cancer has multiple causes and manifestations, there are as many treatments. The most common are surgery, chemotherapy, radiotherapy, hormone therapy, stem-cell transplant and immunotherapy. The choice of treatment is determined by the location of the tumour, distribution, cell type and the patient’s overall condition.

Radiotherapy is the method of treatment in which high waves of energy are delivered using X-ray or other forms of radiation. It has a twofold objective—killing and destroying cancer cells and shrinking the tumour. Radiotherapy can prevent the cancer from recurring either before or after surgery and/or chemotherapy. In case of metastasis, where a cure is not possible, it can be used for lessening pain.

How does radiotherapy work?

It is a local treatment that exclusively targets the part of the body being treated. The objective is to damage only the cancer cells, which divide and grow faster than normal cells. Radiation curbs this growth and division by breaking down the DNA backbone of the cancer, killing these cells.

Radiotherapy is not painful when administered, but the side effects can cause temporary pain and discomfort. The therapy can be conducted through a variety of machines and devices, based on the part of the body affected and the type and stage of the cancer.

Who gets radiation therapy?

More than 60 per cent of cancer patients need radiotherapy. It has also been shown that 80 per cent of patients who receive radiotherapy in early stages are cured. One can undergo radiotherapy in combination with other cancer treatments such as surgery, chemotherapy and immunotherapy. Radiotherapy also helps relieve symptoms such as pain or bleeding.

The treatment team

A radiation oncologist prescribes and implements the treatment while guiding the patient. If the patient requires surgical intervention, they are referred to a surgical oncologist. Similarly, if the patient requires chemotherapy, they are referred to a haemato-oncologist.

The team of doctors creates a customised plan according to the patient’s requirement. As every patient at some point undergoes radiation, a radiation oncologist is a good first point of contact. One should seek treatment at a multidisciplinary setup having expertise in managing the cancer through holistic treatment.

Dietary needs and physical exercise

Radiation causes cancer cells to die and these dead cells are then removed by the body's immune system. The breakdown of cancerous tissue needs to be repaired with good protein intake to allow the body to repair and heal. The body spends a lot of energy to heal during and after radiotherapy.

Most people can continue working full time or part time while undergoing therapy. There may be a feeling of fatigue initially, but one overcomes that quickly. The fatigue can be managed by taking one or two hours of rest over and above the night sleep, doing yoga or relaxing with music.

Protein: Good sources of protein include meat, fish, poultry, dairy products, eggs, nuts, beans and lentils. A protein-rich diet helps maintain a healthy immune system. Talking to a dietician and your radiation oncologist can help you assess your body's requirements.

Carbohydrates and fats: Eat fruits, starchy vegetables, grains like rice, gram flour, quinoa and oatmeal, cereals, beans, peas and honey. To incorporate fats, consume olive oil, nuts, seeds, avocado and butter.

Vitamins and minerals: To ensure proper growth and development of body cells, eat tomatoes, watermelon, cherries, melon, carrots, sweet potatoes, oranges, apples, pears, broccoli, garlic, onions, plums, blueberries, grapes, green tea, oatmeal, quinoa, barley, walnuts and almonds.

Precautionary measures during and after radiation sessions

During radiation sessions, avoid physical exercise if movement causes pain, rapid heart rate, or shortness of breath. One can engage in physical activities like a walk, yoga or pranayama, at a moderate level. Whether one can continue working during the sessions depends on type of treatment, cancer stage, overall health and the nature of work. One can opt for half-days, work from home, keep help at home and plan sessions around weekends to allow the body time to recover. Family support can help patients get through this tough time, especially for mothers with young children at home.

The skin can be sensitive to radiation therapy. Wash it with lukewarm water, do not squeeze or scratch pimples and protect the treated area from the sun and irritants.

Wear cotton clothes as they absorb sweat and prevent skin irritation. Besides this, the doctor will prescribe an emollient or moisturising cream to keep the skin hydrated.

Myths versus reality

It is normal for a patient to be apprehensive about any treatment modality. This fear is increased by misconceptions, including the ones listed below.

Myth: Radiotherapy is painful

Reality: No sensation is felt at the time of delivering the treatment, but the skin can become irritable over time

Myth: Radiotherapy will lead to hair loss

Reality: This happens in chemotherapy

Myth: Radiotherapy causes nausea and vomiting

Reality: This might happen in advanced-stage cancer

Myth: Radiotherapy can enhance risk of breast cancer

Reality: Radiation in one breast does not increase the chance of it affecting the other

Way forward: Immuno-therapy

The introduction of targeted drugs, which are designed to home in on specific genes or proteins, which can be potential cancer cells, has proved to be a boon for cancer patients. Called immunotherapy, this treatment has become the fourth pillar of cancer treatment, alongside surgery, radiation and chemotherapy.

Immunotherapy involves training the body’s own immune system to fight the disease. It can be done by stimulating the immune system to attack cancer cells by taking manmade immune-system proteins. Immunotherapy can also work in collaboration with other types of cancer treatment.

Kataria is chairperson, radiation oncology, Cancer Institute, Medanta, The Medicity.