Stress Management: What stress does to your body and how to reduce it.
Some forms of stress are not harmful to our body such as the stress we [...]READ MORE
Left: Laura A. Dawson, MD, FRCPC, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, ON, Canada. Right: Marissa Sherwood, BSc, MD, University of Toronto Department of Radiation Oncology, Toronto, ON, Canada.
1. What is radiotherapy and what are the main types? (internal, external, radioembolization, brachytherapy)
Radiation treatment or radiotherapy, damages cells in a way that stops them or makes it difficult for them to duplicate. Cells duplicate and multiply constantly – cells are what our bodies and organs are made of. The body has a set of rules for cells – mainly when and for how long they can keep duplicating and growing, and there are limits for each one. Cancerous growths or tumors can happen when cells do not follow these rules and duplicate without limits, which leads to uncontrolled growth beyond where the cells usually reside and possible spread to other organs.
There are different ways to deliver ionizing or damaging radiation to treat cancer. The most common type is external beam radiation therapy (EBRT). You can think of this treatment as high energy x-rays that are made with a special treatment machine – the x-ray beams are made from inside a machine and are sent out in a targeted way at the patient and more specifically, the part of the patient where the cancer is. When radiation treatment is happening, a person lies on a treatment table and the radiation machine moves around them – it looks like getting a CT or CAT scan. During radiation, you cannot see, feel, smell, or hear the x-ray beams. You do not feel burning, and you are not radioactive or dangerous to other people from this treatment. This type of radiation usually happens once a day, for 5 days a week (Monday to Friday) over at least 3 weeks. Stereotactic radiation therapy (SBRT) is a specific type of EBRT, that delivers high doses very precisely around the tumor, with a very high chance of tumor ablation/eradication.
Another type of radiation treatment is called brachytherapy or internal radiation. This is different than external beam radiation. In external beam as described above, x-rays come from outside the patient from a machine and are targeted at the person. In brachytherapy, a radioactive object or source, is placed inside the person to give a high amount of radiation to a very specific spot. Examples of this are in treating cancers of the cervix or prostate, where radiation can be placed directly on the sites of cancer from inside the patient. Rarely brachytherapy is used to treat rectal cancers. In some cases, the radiation stays in the patient forever and gives a small amount of radiation every day (e.g., radioactive beads); in other cases, the radiation is in the patient temporarily and is then removed. Internal radiation has more safety rules for the patients in the short term after their treatment.
A third type of radiation treatment is radiopharmaceuticals, which include drugs that contain radioactive isotopes. An example is Yttrium-90 that is delivered to the liver through the hepatic artery to treat liver metastases.
2. What is it used for? i. rectal cancer, ii. colon cancer, iii. other organs?
Radiation can be used, in some way, for every type of cancer. It can be used to cure cancer on its own, or combined with other treatments like surgery and chemotherapy, and it may be used in place of surgery with the goal of preserving organ function, e.g., anal canal chemo-radiation, reserving surgery for salvage if the cancer recurs. It can also be used to manage pain or other symptoms caused by cancer, such as bleeding or swelling.
3. When would a patient require radiotherapy? i.e., before, during, after surgery.
Some terms a patient might hear about the timing of radiation treatment are “definitive, neoadjuvant, adjuvant, concurrent or palliative”. Definitive radiation means it is the main treatment that is typically done first and may be the only treatment a patient needs. Neoadjuvant radiation means it is delivered before another treatment, such as radiation before surgery or chemotherapy starts. Adjuvant radiation means the radiation is delivered shortly after another treatment finishes. Concurrent radiation means it happens together, at the same time, as another treatment, to help both treatments work better together; it is common for radiation therapy to be delivered concurrently with chemotherapy such as capecitabine. The terms neoadjuvant, adjuvant or concurrent mean the radiation is part of a combination of treatments that work best when delivered together as an overall treatment plan. Palliative radiation means the radiation is being delivered to help treat symptoms – this type of radiation is not intended to cure or get rid of cancers completely.
For colorectal cancers specifically, each patient, depending on the information about their cancer, will require different treatments at different points in time. Many patients with localized rectal cancer are recommended to receive radiation therapy in addition to other therapies to reduce the risk of the cancer returning. Radiation is used less commonly to treat local colon cancer. SBRT is being used more commonly to treat isolated or few sites of metastatic cancer, e.g., in the liver or lung or nodes.
4. How is it used? Alone or in combination with chemotherapy?
Radiation can be used alone and in combination with chemotherapy, depending on the type of cancer being treated, how advanced the cancer is and what the goals of treatment are (i.e., is this to get rid of the cancer, or to help more with symptoms?)
5. What are the criteria for receiving radiotherapy?
There are some reasons why a patient may not be able to get radiation, or it may be more complicated to receive it. These reasons include if a patient is pregnant, if they have had radiation treatment in the past, if they have certain diseases such as lupus, scleroderma or Sjogren’s, if they have a pacemaker or if the person cannot lie flat or still enough for treatment. None of these reasons are absolute contraindications for treatment, but they all make it more complicated to deliver radiation in a safe way.
6. What are the possible side effects and how can we reduce them?
A good way to think about side effects from radiation are splitting them into short- and long-term side effects. Short term side effects are those that occur during or shortly after a person is getting radiation (e.g., within 3 months) while long term side effects can happen months to years later.
Common short term side effects for radiation in the lower abdomen or pelvis, are feeling tired, having more frequent bowel movements, and passing urine more often, having irritation with going to the bathroom (i.e., some burning with passing urine, having diarrhea), more gas, and possibly some nausea. During radiation treatment, each patient has an appointment every week with the radiation doctor to monitor for side effects and help manage them with medications (like Gravol or Imodium) or changes to diet to help with bowel movements for example. These short-term side effects tend to get worse towards the end of radiation treatment – so if, for example, a patient is getting 25 daily treatments, they usually have more side effects in the last few weeks and even for a few weeks after the radiation finishes. The radiation keeps working in the body even after the last treatment has finished.
Long term side effects include permanent changes in a person’s bowel or bladder function – patients may permanently go to the bathroom a bit more often than they did before radiation. The odds of needing a medical treatment or surgery for a severe problem in the bowel or bladder is very rare. People may also notice their skin may become a bit darker, with hair loss and different skin texture in area where skin was irradiated. For all patients, we also consider a very small risk of a second cancer occurring within the radiated region of the body, that may occur many years or decades after radiation therapy is delivered. A general rule of thumb is that after someone has received radiation treatment, their chance of a second cancer being cause by the radiation is about 1% higher after 10 years than someone of the same age who didn’t get radiation. It is important for patients with a prior cancer and prior radiation therapy to have healthy lifestyles, e.g., not smoke or use alcohol excessively, and receive vaccines, to try to reduce the risk of subsequent cancers and long-term side effects.
7. We have heard about Watch and Wait management for rectal cancer. How does radiotherapy fit into this management strategy?
“Watch-and-wait” strategy is a non-invasive treatment approach for selected patients with rectal cancer who have had a complete response after radiation therapy and chemotherapy. Surgery is omitted in this strategy, reserving it for patients who develop a recurrence. This approach requires regular and frequent imaging and scopes to monitor the rectum. This strategy is promising for patients with early rectal cancers; however, it is not ready for routine practice. It is offered on clinical trials to investigate the long-term clinical outcomes of this strategy in comparation to surgical resection that remains the standard of care.
8. Are there any trials in this area that might be of interest to colorectal patients?
There are many clinical trials for colorectal cancer patients, and it is always recommended to ask about open trials when deciding on treatment options. In Canada today (December 2021), there are trials of “watch and wait” radiation therapy for selected patients with rectal cancer. There are also trials of SBRT for patients with 1-10 metastases. Trials open and close often, so it is important to ask your oncologist about what is open. A good web reference for finding open trials in your location is clinicaltrials.gov.
Some forms of stress are not harmful to our body such as the stress we [...]READ MORE
May 2023 Recent data presented at Digestive Disease Week in Chicago [...]READ MORE
May 2023 A patient navigator helps patients through the healthcare [...]READ MORE
Attending a medical appointment can be daunting for some people. It is [...]READ MORE
April 2023 A recent study published in JAMA Oncology found that amo [...]READ MORE
April 2023 A recent study published in JAMA Network Open showed tha [...]READ MORE
March 2023 - Results from a phase I study presented at the American So [...]READ MORE
March 2023 -A German study published in BMC Cancer explored the emotio [...]READ MORE
January 2023 There is increasing evidence to support the use of cir [...]READ MORE
January 2023 Findings from the phase III SUNLIGHT trial were presente [...]READ MORE
Locations: BC, AB, ON, QC Status: currently recruiting Trial descr [...]READ MORE
November 2022 A new study involving patients with different cancer [...]READ MORE
November 2022 To better understand the role of the gut microbiome i [...]READ MORE
October 2022 A recent study published in the Journal of the Nationa [...]READ MORE
Earlier this month, controversial news headlines emerged: “Colonoscopi [...]READ MORE
Location: Canada-wide Status: Currently recruiting Trial Descrip [...]READ MORE
Findings from the global FRESCO-2 trial showed that a drug called fruq [...]READ MORE
Findings from a study published in the Journal of Clinical Oncology de [...]READ MORE
Ulcerative colitis is a chronic inflammatory bowel disease that affect [...]READ MORE
Crohn’s disease is a chronic (long-term) inflammatory disease that can [...]READ MORE
In this Q&A, Dr. Brandon Sheffield, Pathologist with the William O [...]READ MORE
In this Q&A, Suzanne Zwicker, Clinical Pharmacist on the National [...]READ MORE
July 2022 The annual ESMO World Congress on Gastrointestinal (GI) C [...]READ MORE
July 2022 Patients who have colorectal cancer that has spread to th [...]READ MORE
June 2022 Minimal residual disease (MRD) is a term that refers to cance [...]READ MORE
May 2022. Image source: https://www.whathealth.com/breastcancer/her2rec [...]READ MORE
May 2022 The KEYNOTE-177 trial is a landmark study in colorectal ca [...]READ MORE
April 2022. A new study from Australia found that heavy drinking in [...]READ MORE
April 2022. A study published in JAMA Network Open investigated whe [...]READ MORE
March 2022. While obesity is a known risk factor for colorectal can [...]READ MORE
https://youtu.be/-Oi2jBJDUNc February 2022. Join Patient Support Spe [...]READ MORE
January 2022 Total neoadjuvant therapy (TNT) is a standard approach [...]READ MORE
January 2022 Oxaliplatin is an important intravenous chemotherapy d [...]READ MORE
January 2022. Laura Ferguson, a current ileostomy patient, and Karen Br [...]READ MORE
Join Chana, our Patient Support Specialist, as she sits down to a cand [...]READ MORE
Join Dr. Scott Berry, Professor & Department Head, Department of O [...]READ MORE
This month, the Food and Drug Administration (FDA) cleared an investig [...]READ MORE
In 2016, the United States Preventive Services Task Force (U [...]READ MORE
In 2020, Jason was diagnosed with stage 3b colorectal cancer at age 36. In [...]READ MORE
Dr. Megan Bernard, naturopathic doctor, discusses a variety of tips and su [...]READ MORE
Nutritionist Jill Haverstock discusses a variety of tips and suggestions t [...]READ MORE
Dr. Mel Borins is a family practitioner based in Toronto, Ontario. He crea [...]READ MORE
Jason Abramovitch is an early age onset stage 3b colon cancer survivor who [...]READ MORE
On December 3rd 2021, Physiotherapist Thi Tran gave a compelling session o [...]READ MORE
November 2021 Findings from a recent study published in JAMA Networ [...]READ MORE
November 2021 Findings from phase II of the CheckMate-142 trial sho [...]READ MORE
The EPOCH trial is the first phase III international study evaluating the [...]READ MORE
Immunotherapy has revolutionized the way cancer is treated by boosting [...]READ MORE
Colorectal (CRC) cancer screening and diagnosis during the COVID-19 pa [...]READ MORE
A Swedish population study published this month in the Journal of the [...]READ MORE
Adjuvant (post-surgical) chemotherapy is useful in reducing the risk o [...]READ MORE
The fecal immunochemical test (FIT) is a widely used colorectal cancer [...]READ MORE
New findings from a study presented at the European Society for Medica [...]READ MORE
While many different risk factors for colorectal cancer (CRC) have bee [...]READ MORE
Findings from a recent study show that multigene panel testing of patients [...]READ MORE
The final recommendation from the United States Preventive Services Ta [...]READ MORE
Periodontal disease (PD) is a set of inflammatory conditions that affect t [...]READ MORE
The US Food and Drug Administration (FDA) recently approved the market [...]READ MORE
We've posted some new recipe videos on our sister site, Foods that Fight C [...]READ MORE
The Ontario Cancer Research Institute (OICR) held a conference on Tran [...]READ MORE
April is Diversity Month dedicated to celebrating and honouring all in [...]READ MORE
Results from a systematic review published in JAMA Oncology found that [...]READ MORE
A study published in the Journal of Clinical Oncology Precision Oncology s [...]READ MORE
Molecular profiling in gastrointestinal (GI) cancer has been named by [...]READ MORE
Your physical, emotional and mental well-being are vital to your ability t [...]READ MORE
New findings from the University of Alberta published in the Journal of th [...]READ MORE
Findings from a recent study presented at the 2021 Gastrointestinal Ca [...]READ MORE
Colorectal cancer is the second most diagnosed cancer in Canada. Twent [...]READ MORE
10 December 2020Findings from a recent study showed that people who regula [...]READ MORE
22 December 2020 Hepatic Artery Infusion (HAI) chemotherapy is sometime [...]READ MORE
November 2020 Findings from a recent study conducted by the Mayo Clinic [...]READ MORE
The non-surgical management or “watch-and-wait” approach for rectal c [...]READ MORE
The incidence of colorectal cancer (CRC) is rising among young adults, who [...]READ MORE
Opportunity to Investigate the Microbiome’s Impact on Science and Treatmen [...]READ MORE
New findings from a study conducted at the University of Sheffield in [...]READ MORE
Sexuality and relationships during and after cancer is extremely impor [...]READ MORE
Chadwick Boseman’s death from colorectal cancer (CRC) at age 43 was a shoc [...]READ MORE
Today, Wednesday September 30th, is World Metastatic Colorectal Cancer Day [...]READ MORE
Dr. Heinz-Josef Lenz, MD, discusses optimal sequencing strategies for [...]READ MORE
The European Society for Medical Oncology ESMO Virtual Congress 2020 t [...]READ MORE
Jesse Fishman is a 17-year-old hockey player, currently playing for the Ki [...]READ MORE
12 August 2020 Recent findings from a Swedish cohort study found that p [...]READ MORE
It was the day of the lockdown. My family doctor called. “The colorectal c [...]READ MORE
Fill out the survey! The world was shocked late last week as we learned a [...]READ MORE
Previous data have shown that certain species of intestinal bacteria not o [...]READ MORE
As we transition into autumn, take a moment to appreciate the seasonal pro [...]READ MORE
The COVID-19 pandemic has presented countless new challenges in cancer car [...]READ MORE
The COVID-19 pandemic situation is constantly evolving. Canada is slowly r [...]READ MORE
Results of several new studies provide important perspectives on the use o [...]READ MORE
In the past two years, findings from important clinical trials are shaping [...]READ MORE
Hold the Date! On behalf of Colorectal Cancer Canada (CCC), you are cordi [...]READ MORE
What is Lynch Syndrome? Lynch syndrome is a genetically inherited conditi [...]READ MORE
Coronavirus has taken the world by storm since the beginning of 2020, and [...]READ MORE
To ensure the health and safety of our participants, volunteers, staff and [...]READ MORE
The American Society of Clinical Oncology (ASCO) held its annual meeting a [...]READ MORE
In just a few months, coronavirus (COVID-19) has transformed our lives. De [...]READ MORE
It has been known for millennia that what we eat can be powerful medicine [...]READ MORE
The last few decades have seen important advances in colorectal cancer tre [...]READ MORE
Co-leads of Push For Your Tush Ottawa share their connection to the cause [...]READ MORE
The Centre de recherche of the Centre hospitalier universitaire de Sherbro [...]READ MORE
On June 24, 2019, colorectal cancer screening in Ontario is changing to th [...]READ MORE
Today we remember Dr. Henry Lynch, esteemed researcher and father of hered [...]READ MORE
On Tuesday, July 16, Colorectal Cancer Canada (CCC) held our third annual [...]READ MORE
Researchers with the World Health Organization confirm increased rates of [...]READ MORE
Last Thursday and Friday, Morgan Kennedy, CCC’s Never Too Young Program Ma [...]READ MORE
Colorectal Cancer Canada (CCC) is proud to announce the publication of the [...]READ MORE
Today, the Giant Colon Tour stopped at the University of Montreal Hospital [...]READ MORE
Most people do not know that cancer is the number one cause of death among [...]READ MORE
March is Colorectal Cancer Awareness Month! Colorectal cancer may touch yo [...]READ MORE