Achilles Tendon Repair Surgery

What is Achilles tendon repair surgery?

Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon.

The Achilles tendon is a strong, fibrous cord in the lower leg. It connects the muscles of your calf to your heel. It’s the largest tendon in your body. It helps you walk, run, and jump.

In some cases, the Achilles tendon can tear, or rupture. This is usually due to a sudden, strong force. It can happen during tough physical activity. It can happen if you suddenly move faster or pivot on your foot. Having a foot that turns outward too much can increase your risk of a torn tendon. A ruptured Achilles tendon can cause pain and swelling near your heel. You may not be able to bend your foot downward.

The Achilles tendon can also degenerate. This is also known as tendinitis or tendinopathy. This might cause symptoms like pain and stiffness along your Achilles tendon and on the back of your heel. This is most often through overuse and repeated stress to the tendon. It can result from repeated stress on your tendon, especially if you have recently been more active. Having short calf muscles can increase your risk of tendinopathy.

During the surgery, an incision is made in the back of the calf. If the tendon is ruptured, the surgeon will stitch the tendon back together. If the tendon is degenerated, the surgeon may remove the damaged part of the tendon and repair the rest of the tendon with stitches. If there is severe damage to a lot of the tendon, the surgeon might replace part or all of your Achilles tendon. This is done with a tendon taken from another place in your foot.

In some cases, the Achilles tendon repair surgery can be done as a minimally invasive procedure. This is done with several small incisions instead of one large one. It may use a special scope with a tiny camera and a light to help do the repair.

Why might I need Achilles tendon repair surgery?

You might need Achilles tendon surgery if you tore your tendon. Surgery is advised for many cases of a ruptured Achilles tendon. But in some cases, your healthcare provider may advise other treatments first. These may include pain medicine, or a temporary cast to prevent your leg from moving. And your healthcare provider may not advise surgery if you have certain medical conditions. These include diabetes and neuropathy in your legs.

Or you may need Achilles tendon repair surgery if you have tendinopathy. But in most cases, other treatments can be used to treat tendinopathy. These include resting your foot, using ice and pain medicines, and using a brace or other device to stop your foot from moving. Physical therapy can also help. If you still have symptoms after several months, your healthcare provider might advise surgery.

Depending on the type of problem you have, Achilles tendon surgery might work for you. Talk with your healthcare provider about the risks and benefits of your choices.

What are the risks of Achilles tendon repair surgery?

Every surgery has risks. Risks of Achilles tendon repair include:

Excess bleeding

Nerve damage

Infection

Blood clot

Wound healing problems

Calf weakness

Complications from anesthesia

Continued pain in your foot and ankle

Your own risks may vary according to your age, the shape of your foot and leg muscles and tendons, your general health, and the type of surgery done. Talk to your healthcare provider about any concerns you have. He or she can tell you the risks that most apply to you.

How do I prepare for Achilles tendon repair surgery?

Talk with your healthcare provider how to prepare for your surgery. Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.

Before your surgery, you may need imaging tests. These may include ultrasound, X-rays, or magnetic resonance imaging (MRI).

Do not eat or drink after midnight the night before your surgery. Tell your healthcare provider about any recent changes in your health, such as a fever.

You may need to plan some changes at home to help you recover. This is because you won’t be able to walk on your foot normally for a while. Plan to have someone drive you home from the hospital.

What happens during Achilles tendon repair surgery?

Achilles tendon surgery can be done with several methods. The surgery is done by an orthopedic surgeon and a team of specialized healthcare providers. Ask your healthcare provider about the details of your surgery. The surgery may take a couple of hours. During your surgery:

You may have spinal anesthesia. This is so you won’t feel anything from your waist down. You’ll also likely be given sedation. This will help you sleep through the surgery.

A healthcare provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.

The surgeon will make an incision through the skin and muscle of your calf. If you have minimally invasive surgery, the surgeon will make a smaller incision. He or she may then use a tiny camera with a light to help do the surgery.

Your surgeon will make an incision through the sheath that surrounds the tendon. He or she will remove parts of your damaged tendon, or repair the rip in the tendon.

Your surgeon may remove another tendon from your foot. This is then used to replace part or all of the Achilles tendon.

Your surgeon will make any other repairs that are needed.

The healthcare provider will close the layers of skin and muscle around your calf with sutures.

What happens after Achilles tendon repair surgery?

A healthcare provider will watch you for a few hours after your surgery. When you wake up, you will likely have your ankle in a splint. This is to keep it from moving. Achilles tendon surgery is often an outpatient procedure. This means you can go home the same day.

You will have some pain after your surgery, especially in the first few days. Pain medicines will help relieve your pain. Keep your leg elevated as often as possible. This can help reduce swelling and pain. Make sure to tell your healthcare provider right away if you have a high fever or pain in your ankle or calf that gets worse. After your surgery, you will likely need to use crutches. This is so you can keep your weight off your leg.

About 10 days after your surgery, you’ll need to return to your healthcare provider to have your stitches removed. Your healthcare provider might replace your splint with a cast at this time. If so, follow all instructions about keeping your cast dry. Or, your healthcare provider may give you a special removable boot instead of a cast.

Your healthcare provider will give you instructions about when you can put weight on your leg. He or she will tell you how to strengthen your ankle and leg muscles as you recover. You may need to do physical therapy to help with your recovery.

Make sure to follow all your healthcare provider’s instructions about medicines, wound care, and exercises. This will help make sure the surgery is a success for you.

Next steps

Before you agree to the test or the procedure make sure you know:

The name of the test or procedure

The reason you are having the test or procedure

What results to expect and what they mean

The risks and benefits of the test or procedure

What the possible side effects or complications are

When and where you are to have the test or procedure

Who will do the test or procedure and what that person’s qualifications are

What would happen if you did not have the test or procedure

Any alternative tests or procedures to think about

When and how will you get the results

Who to call after the test or procedure if you have questions or problems

How much will you have to pay for the test or procedure

And Also:

Achilles Tendon Repair

Description

The Achilles Tendon connects the calf muscles to the calcaneus (heel bone) and is one of the important tendons in the human body. The main action of the achilles tendon is foot plantar flexion. Common pathologies include: tendinopathy, tear or rupture. Examples of mechanisms of injury for rupture includes: falling from a height, forceful plantar flexion of the ankle (as in jumping with an extended knee), or using the foot to break a fall if you stumble. Clinically they present with a palpable gap on palpation, increased passive dorsiflexion, lack of heel raise and a positive Thompson Test. Achilles tendon rupture is either managed conservatively with a cast or surgically with an achilles tendon repair.

Conservative vs Surgical Intervention

There is much debate in the literature about treatment for achilles tendon rupture with the two options comprising of a conservative or surgical approach. Many studies have shown that the re-rupture rates are higher in cases of non-operative management. More recently studies have demonstrated equivalent or improved rates of re-rupture compare with surgical intervention. However, many people continue to be treated with surgical repair and physiotherapists will continue to see them for post-operative rehabilitation in their clinics.

Pre-op

Prior to surgery general oedema reduction interventions should be utilised (Rest, Ice, Compression, Elevation). The surgery will ideally occur within one week of the rupture.

Surgery Description

Many techniques exist for this surgery, including transverse, medial and longitudinal incisions. The ankle is placed in neutral position and the severed ends of the tendon are sutured together. The surgeon will then take the ankle through complete range of motion to look at the integrity of the repair. A cast is often applied, with the surgical technique determining how long the cast stays on. Many surgeons are now focusing on early weight bearing and passive motion to improve tendon healing. A new minimally-invasive technique involves utilisation of the peroneus brevis via two para-midline incisions. The technique reportedly preserves skin integrity over the site most prone to breakdown in a vertical incision, open reconstruction. Another study recommended percutaneous repair in the recreational athlete and in patients concerned with cosmesis, and open repair for all high-caliber athletes who cannot afford any chance of rerupture."

Post-Op

Early mobilisation following achilles tendon repair has been reported to be beneficial in terms of postoperative recovery and improved tendon vascularity. Despite the increasing supported for accelerated rehabilitation regimes, there is still no consensus regarding the most preferable protocol. 

Clinic protocols:

There's three phases of post-surgical rehabilitation following achilles tendon repair. 

Phase I

Phase I typically lasts three weeks.

Goals of this phase are as follows:

Control oedema and protect the repair site

Minimise scar adhesion and detrimental effects of immobilisation

Progress to full weight bearing as tolerated/indicated

Pain 5/10 or less, strength 4/5 all lower extremity muscles except plantar flexors

Phase I interventions include:

Modalities for pain and oedema

Stretching of large lower extremity muscle groups, gastrocnemius/soleus added at week 3

AROM: plantar and dorsiflexion 3x5; 3 times daily; add inversion and eversion at week 2

Foot/ankle isometrics at week 2; band exercises week 3

Proprioceptive training for lower extremities; Gait training

Upper extremity cardiovascular exercise

Joint mobilisation and soft tissue work, as indicated

Phase II

Phase II typically lasts from post op week 4-6.

Goals for this phase are as follows:

Normalized gait pattern

Full ankle ROM

5/5 lower extremity strength

Return to full ADL ability

Pain reported to be <2/10

Proprioceptive reactions equal to non-surgical side

Phase II interventions include:

Ankle flexibility at various knee angles

Progressive closed kinetic chain lower extremity strengthening

Cardiovascular progression

Proprioceptive training on variety of surfaces

Manual resisted exercises and joint mobilization, as indicated

Phase III

Phase III typically lasts from post op week 6-15.

Goals for this phase are as follows:

Initiate running program

Improve balance and coordination

Increase velocity of activity

Return to sport

Phase III interventions include:

Progressive ankle and lower extremity strengthening

Agility exercises

Double heel raise/lower progressing to single leg heel raise at various speeds

Anterior Cruciate Ligament ACL Reconstruction Surgery

Anterior Cruciate Ligament ACL Reconstruction

Overview

ACL reconstruction is surgery to replace a torn anterior cruciate (KROO-she-ate) ligament (ACL) — a major ligament in your knee. ACL injuries most commonly occur during sports that involve sudden stops and changes in direction — such as basketball, soccer, football, downhill skiing and gymnastics.

In ACL reconstruction, the torn ligament is removed and replaced with a piece of tendon from another part of your knee or from a deceased donor. This surgery is an outpatient procedure that's performed through small incisions around your knee joint.

ACL reconstruction is performed by a doctor who specializes in surgical procedures of the bones and joints (orthopedic surgeon).

Anterior cruciate ligament

Ligaments are strong bands of tissue that connect one bone to another. The ACL — one of two ligaments that crosses the middle of the knee — connects your thighbone (femur) to your shinbone (tibia) and helps stabilize your knee joint.

Why it's done

Most ACL injuries happen during sports and fitness activities that can put stress on the knee:

Suddenly slowing down and changing direction (cutting)

Pivoting with your foot firmly planted

Landing from a jump incorrectly

Stopping suddenly

Receiving a direct blow to the knee

A course of physical therapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees.

ACL reconstruction is generally recommended if:

You're an athlete and want to continue in your sport, especially if the sport involves jumping, cutting or pivoting

More than one ligament or the meniscus in your knee is injured

The injury is causing your knee to buckle during everyday activities

You're young (though other factors, such as activity level and knee instability, are more important than age)

Risks

ACL reconstruction is a surgical procedure. And, as with any surgery, bleeding and infection at the surgical site are potential risks. Other risks associated with ACL reconstruction include:

Knee pain or stiffness

Poor healing of the graft

Graft failure after returning to sport

How you prepare

Before your surgery, you'll likely undergo several weeks of physical therapy. The goal before surgery is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. People who go into surgery with a stiff, swollen knee may not regain full range of motion after surgery.

ACL reconstruction is an outpatient procedure, so you'll be able to go home the same day. Arrange for someone to drive you home.

Food and medications

Tell your surgeon about any medications or dietary supplements you take. If you regularly take aspirin or other blood-thinning medications, your doctor may ask you to stop taking these types of drugs for at least a week before surgery to reduce your risk of bleeding.

Follow your doctor's instructions about when to stop eating, drinking and taking any other medication the night before your surgery.

What you can expect

General anesthesia is typically used during ACL reconstruction, so you'll be comfortable during the procedure. ACL reconstruction is usually done through small incisions — one to hold a thin, tube-like video camera (arthroscope) and others to allow surgical instruments access to the joint space.

During the procedure

Your surgeon will remove your damaged ligament, and then replace it with a segment of tendon. This replacement tissue is called a graft and it comes from another part of your knee or a tendon from a deceased donor.

Your surgeon will drill sockets or tunnels into your thighbone and shinbone to accurately position the graft, which is then secured to your bones with screws or other fixation devices. The graft will serve as scaffolding on which new ligament tissue can grow.

After the procedure

Once you recover from the anesthesia, you can go home later that same day. Before you go home, you'll practice walking with crutches, and your surgeon may ask you to wear a knee brace or splint to help protect the graft.

Your doctor will give you specific instructions on how to control swelling and pain after surgery. In general, it's important to keep your leg elevated, apply ice to your knee and rest as much as possible.

Medications to help with pain relief include over-the-counter drugs such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Your doctor might prescribe stronger medications, such as meloxicam (Mobic, Vivlodex, others) and gabapentin (Neurontin). If opioids are prescribed, they should be taken only for breakthrough pain as they have many side effects and a significant risk of addiction.

Follow your surgeon's advice on when to ice your knee, how long to use crutches and when it's safe to bear weight on your knee. You'll also be instructed when you can shower or bathe, when you should change dressings on the wound, and how to manage post-surgery care.

Progressive physical therapy after ACL surgery helps to strengthen the muscles around your knee and improve flexibility. A physical therapist will teach you how to do exercises that you will perform either with continued supervision or at home. Following the rehabilitation plan is important for proper healing and achieving the best possible outcomes.

Results

Successful ACL reconstruction paired with focused rehabilitation can usually restore stability and function to your knee. Within the first few weeks after surgery, you should strive to regain a range of motion equal to that of your opposite knee. Recovery generally takes about nine months.

It may take eight to 12 months or more before athletes can return to their sports.

And Also:

ACL Surgery

A torn ACL (anterior cruciate ligament) is a painful and potentially debilitating condition. ACL tears are very common. 

Each year in the United States, between 100,000 to 200,000 people tear their ACL. The ACL cannot heal on its own. Once torn, it will stay torn unless surgery is performed.

For some patients – mainly older people and others whose lifestyles do not include running or other rigorous excercise – conservative, nonsurgical treatments may allow them to successfully return to their normal routines.

However, anyone who has torn their ACL and returns to unrestricted activity without an intact ACL will likely experience some knee instability. Most people with active lifestyles, especially those who participate in competitive sports or other rigorous athletic activities, will need surgery to return to their prior level of activity and avoid future injury.

Without an intact ACL, a person is also much more likely to tear their meniscus. The meniscus is a pad of cartilage that cushions the bones that meet at the knee joint. There are two menisci on each knee: the medial meniscus on the inside of the knee and the lateral meniscus on the outside. A torn meniscus will cause knee pain and, sometimes swelling. More importantly, however, a damaged meniscus increases a patient's risk of developing osteoarthritis of the knee later in life.

Most people with active lifestyles, especially those who engage in competitive sports, will need ACL surgery in order to reduce the risk of future injury.

What does ACL surgery do?

In most cases, it is not possible to surgically repair or reattach a torn ACL. Most often, ACL surgery involves a complete rebuilding of the ACL. This procedure, called ACL reconstruction, is the current standard of care for surgically treating tears of the ACL.

The surgeons at the HSS Sports Medicine Institute have drafted guidelines for people who are considering ACL treatment.

How does ACL surgery work?

In ACL reconstruction surgery, a new ACL is made from a graft of replacement tissue from one of two sources:

a portion of the patient's own hamstring, quadriceps or patellar tendon

an allograft (tissue from a human organ donor)

The type of graft used for each patient is determined on a case-by-case basis.

ACL reconstruction surgery is performed using minimally invasive arthroscopic techniques, in which a combination of fiber optics, small incisions and small instruments are used. A somewhat larger incision is needed, however, to obtain the tissue graft. ACL reconstruction is an outpatient (ambulatory) procedure, in which patients can go home on the same day as their surgery.

At HSS, most patients who undergo ACL reconstruction are given an epidural nerve block during their surgery, rather than being placed fully unconscious under general anesthesia. This epidural is the same type of regional anesthesia many women receive during childbirth.

ACL reconstruction surgery steps

Reconstruction of the ACL follows a number of basic steps, although they may vary slightly from case to case:

The orthopedic surgeon makes small incisions around the knee joint, creating portals of entry for the arthroscope and surgical instruments.

The arthroscope is inserted into the knee and delivers saline solution to expand the space around the joint. This makes room for surgical tools, including the arthroscopic camera, which sends video to a monitor so that the surgeon can see inside the knee joint.

The surgeon then evaluates structures that surround the torn ACL, including the left and right meniscus and the articular cartilage. If either of these soft tissues have any lesions, the surgeon repairs them.

Next the graft will be harvested (unless a donor allograft is used). A section of tendon from another part of the patient's body is cut to create a graft, which is then attached at each end to plugs of bone taken from the patella and tibia. These plugs help to anchor the graft that will become the new ACL.

The surgeon inserts the new ACL into the femur and tibia using a flexible guide wire.

Screws are used to secure the plugs of bone. Over time, these plugs will be incorporated into the surrounding bone.

The surgical instruments are removed to complete the procedure.

How soon should you get ACL surgery?

ACL reconstruction is generally scheduled for between three and six weeks after the injury occurs. This allows inflammation in the area to subside. If surgery is performed too early, patients may develop a profound scarring response called arthrofibrosis.

Orthopedic surgeons gauge the appropriate timing of surgery based on:

whether there are other injuries present that need to be treated first

the physical appearance of the knee

the patient’s level of pain

the patient's range of motion and quality of muscle control when flexing (bending) or extending (straightening) the leg

What is the recovery time for ACL surgery?

It usually takes six to nine months for a patient to return to participating in sports after an ACL reconstruction, depending on the level of competition and the type of activity.

Patients are able to walk with crutches and a leg brace on the day of surgery. Very soon after surgery, the patient enters a rehabilitation program to restore strength, stability and range of motion to the knee. The rehabilitation process is composed of a progression of exercises:

Strengthening and range-of-motion exercises are started early in the recovery period.

Running exercises begin at about four months.

Pivoting exercises are started at around five months.

Return to playing competitive sports can begin as early as six months.

The degree of pain associated with ACL recovery varies and can be addressed successfully with medication. Recovery time also varies from patient to patient. The determination of when a patient has fully recovered is based on the restoration of muscle strength, range of motion and proprioception of the knee joint.

Arthroscopic surgical techniques have made recovery times quicker and easier, compared to when ACL construction was conducted through open surgery. But to achieve a successful outcome, it is critical to have the rehabilitation period carefully supervised by an appropriate physical therapist and to have follow-up appointments with the surgeon.

Cancer And Chemotherapy

Understanding Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells. It usually works by keeping the cancer cells from growing, dividing, and making more cells. Because cancer cells usually grow and divide faster than normal cells, chemotherapy has more of an effect on cancer cells. However, the drugs used for chemotherapy are powerful, and they can still cause damage to healthy cells. This damage causes the side effects that are linked with chemotherapy.

Different types of chemotherapy

Treatment with these powerful drugs is called standard chemotherapy, traditional chemotherapy, or cytotoxic chemotherapy.

How does chemotherapy treat cancer?

Doctors use chemotherapy in different ways at different times. 

These include:

Before surgery or radiation therapy to shrink tumors. This is called neoadjuvant chemotherapy.

After surgery or radiation therapy to destroy any remaining cancer cells. This is called adjuvant chemotherapy.

As the only treatment. For example, to treat cancers of the blood or lymphatic system, such as leukemia and lymphoma.

For cancer that comes back after treatment, called recurrent cancer.

For cancer that has spread to other parts of the body, called metastatic cancer.

The goals of chemotherapy

The goals of chemotherapy depend on the type of cancer and how far it has spread. Sometimes, the goal of treatment is to get rid of all the cancer and keep it from coming back. If this is not possible, you might receive chemotherapy to delay or slow cancer growth.

Delaying or slowing cancer growth with chemotherapy also helps manage symptoms caused by the cancer. Chemotherapy given with the goal of delaying cancer growth is sometimes called palliative chemotherapy.

Your chemotherapy plan

There are many drugs available to treat cancer. A doctor who specializes in treating cancer with medication, called a medical oncologist, will prescribe your chemotherapy. You may receive a combination of drugs, because this sometimes works better than only 1 drug.

The drugs, dose, and treatment schedule depend on many factors. 

These include:

The type of cancer

The tumor size, its location, and if or where it has spread. This is called the stage of cancer.

Your age and general health

How well you can cope with certain side effects

Any other medical conditions you have

Previous cancer treatments

Where is chemotherapy given?

Your health care team may give you chemotherapy at the clinic, doctor's office, or hospital. Some types of chemotherapy are given by mouth, and these can be taken at home.

How long does chemotherapy take?

Chemotherapy is often given for a specific time, such as 6 months or a year. Or you might receive chemotherapy for as long as it works.

Side effects from many drugs are too severe to give treatment every day. Doctors usually give these drugs with breaks, so you have time to rest and recover before the next treatment. This lets your healthy cells heal.

For example, you might get a dose of chemotherapy on the first day and then have 3 weeks of recovery time before repeating the treatment. Each 3-week period is called a treatment cycle. Several cycles make up a course of chemotherapy. A course usually lasts 3 months or more.

Some cancers are treated with less recovery time between cycles. This is called a dose-dense schedule. It can make chemotherapy more effective against some cancers. But it also increases the risk of side effects. Talk with your health care team about the best schedule for you.

How is chemotherapy given?

Chemotherapy may be given in several different ways, which are discussed below.

Intravenous (IV) chemotherapy. Many drugs require injection directly into a vein. 

This is called intravenous or IV chemotherapy. Treatment takes a few minutes to a few hours. 

Some IV drugs work better if you get them over a few days or weeks. You take them through a small pump you wear or carry.

This is called continuous infusion chemotherapy.

Oral chemotherapy. You can take some drugs by mouth. They can be in a pill, capsule, or liquid. This means that you may be able to pick up your medication at the pharmacy and take it at home. Oral treatments for cancer are now more common. Some of these drugs are given daily, and others are given less often. For example, a drug may be given daily for 4 weeks followed by a 2-week break.

Injected chemotherapy. This is when you receive chemotherapy as a shot. The shot may be given in a muscle or injected under the skin. You may receive these shots in the arm, leg, or abdomen. Abdomen is the medical word for your belly.

Chemotherapy into an artery. An artery is a blood vessel that carries blood from your heart to another part of your body. Sometimes chemotherapy is injected into an artery that goes directly to the cancer. This is called intra-arterial or IA chemotherapy.

Chemotherapy into the peritoneum or abdomen. For some cancers, medication might be placed directly in your abdomen. This type of treatment works for cancers involving the peritoneum. The peritoneum covers the surface of the inside of the abdomen and surrounds the intestines, liver, and stomach. Ovarian cancer is one type of cancer that frequently spreads to the peritoneum.

Topical chemotherapy. You can take some types of chemotherapy in a cream you put on your skin. You get your medication at the pharmacy and take it at home.

And Also:

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to kill cancer 

How Chemotherapy Works against Cancer

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy is used to:

Treat cancer

Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth.

Ease cancer symptoms

Chemotherapy can be used to shrink tumors that are causing pain and other problems.

Who Receives Chemotherapy

Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, you will have chemotherapy and other cancer treatments. The types of treatment that you need depends on the type of cancer you have, if it has spread and where, and if you have other health problems.

How Chemotherapy Is Used with Other Cancer Treatments

When used with other treatments, chemotherapy can:

Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant chemotherapy.

Destroy cancer cells that may remain after treatment with surgery or radiation therapy. This is called adjuvant chemotherapy.

Help other treatments work better.

Kill cancer cells that have returned or spread to other parts of your body.

Chemotherapy Can Cause Side Effects

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.

The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for fatigue by:

Asking someone to drive you to and from chemotherapy

Planning time to rest on the day of and day after chemotherapy

Asking for help with meals and childcare on the day of and at least one day after chemotherapy

There are many ways you can help manage chemotherapy side effects. 

How Much Chemotherapy Costs

The cost of chemotherapy depends on:

The types and doses of chemotherapy used

How long and how often chemotherapy is given

Whether you get chemotherapy at home, in a clinic or office, or during a hospital stay

The part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for chemotherapy. To learn more, talk with the business office where you go for treatment.

If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for "financial assistance." Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

What to Expect When Receiving Chemotherapy

How Chemotherapy Is Given

Chemotherapy may be given in many ways. Some common ways include:

Oral

The chemotherapy comes in pills, capsules, or liquids that you swallow

Intravenous (IV)

The chemotherapy goes directly into a vein

Injection

The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly

Intrathecal

The chemotherapy is injected into the space between the layers of tissue that cover the brain and spinal cord

Intraperitoneal (IP)

The chemotherapy goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver

Intra-arterial (IA)

The chemotherapy is injected directly into the artery that leads to the cancer

Topical

The chemotherapy comes in a cream that you rub onto your skin

Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. IV chemotherapy may also be given through catheters or ports, sometimes with the help of a pump.

Catheter

A catheter is a thin, soft tube. A doctor or nurse places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until you have finished your chemotherapy treatments. Catheters can also be used to give you other drugs and to draw blood. Be sure to watch for signs of infection around your catheter. 

Port

A port is a small, round disc that is placed under your skin during minor surgery. A surgeon puts it in place before you begin your course of treatment, and it remains there until you have finished. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for longer than one day. Be sure to watch for signs of infection around your port. 

Pump

Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port, allowing you to receive your chemotherapy outside of the hospital. Pumps can be internal or external. External pumps remain outside your body. Internal pumps are placed under your skin during surgery.

How Your Doctor Decides Which Chemotherapy Drugs to Give You

There are many different chemotherapy drugs. Which ones are included in your treatment plan depends mostly on:

The type of cancer you have and how advanced it is

Whether you have had chemotherapy before

Whether you have other health problems, such as diabetes or heart disease

Where You Go for Chemotherapy

You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctor’s office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them. 

How Often You Receive Chemotherapy

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:

Your type of cancer and how advanced it is

Whether chemotherapy is used to:

Cure your cancer

Control its growth

Ease symptoms

The type of chemotherapy you are getting

How your body responds to the chemotherapy

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive chemotherapy every day for 1 week followed by 3 weeks with no chemotherapy. These 4 weeks make up one cycle. The rest period gives your body a chance to recover and build new healthy cells.

Missing a Chemotherapy Treatment

It is best not to skip a chemotherapy treatment. But, sometimes your doctor may change your chemotherapy schedule if you are having certain side effects. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

How Chemotherapy May Affect You

Chemotherapy affects people in different ways. How you feel depends on:

The type of chemotherapy you are getting

The dose of chemotherapy you are getting

Your type of cancer

How advanced your cancer is

How healthy you are before treatment

Since everyone is different and people respond to chemotherapy in different ways, your doctor and nurses cannot know for sure how you will feel during chemotherapy.

How Will I Know If My Chemotherapy Is Working?

You will see your doctor often. During these visits, she will ask you how you feel, do a physical exam, and order medical tests and scans. Tests might include blood tests. Scans might include MRI, CT, or PET scans.

You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

Special Diet Needs

Chemotherapy can damage the healthy cells that line your mouth and intestines and cause eating problems. Tell your doctor or nurse if you have trouble eating while you are receiving chemotherapy. You might also find it helpful to speak with a dietitian. 

Working during Chemotherapy

Many people can work during chemotherapy, as long as they match their work schedule to how they feel. Whether or not you can work may depend on what kind of job you have. If your job allows, you may want to see if you can work part-time or from home on days you do not feel well.

Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.

Arthroscopic Knee Surgery

Arthroscopy (ahr-THROS-kuh-pee) is a procedure for diagnosing and treating joint problems. A surgeon inserts a narrow tube attached to a fiber-optic video camera through a small incision — about the size of a buttonhole. The view inside your joint is transmitted to a high-definition video monitor.

Arthroscopy allows the surgeon to see inside your joint without making a large incision. Surgeons can even repair some types of joint damage during arthroscopy, with pencil-thin surgical instruments inserted through additional small incisions.

Why it's done

Doctors use arthroscopy to help diagnose and treat a variety of joint conditions, most commonly those affecting the:

Knee,  Shoulder,  Elbow,  Ankle,  Hip,  Wrist

Diagnostic procedures

Doctors often turn to arthroscopy if X-rays and other imaging studies have left some diagnostic questions unanswered.

Surgical procedures

Conditions treated with arthroscopy include:

Loose bone fragments,  Damaged or torn cartilage,  Inflamed joint linings,  Torn ligaments,  Scarring within joints,  Arthritis,  Posterior cruciate ligament injury,  Swollen knee

Risks

Arthroscopy is a very safe procedure and complications are uncommon. 

Problems may include:

Tissue or nerve damage. The placement and movement of the instruments within the joint can damage the joint's structures.

Infection. Any type of invasive surgery carries a risk of infection.

Blood clots. Rarely, procedures that last longer than an hour can increase the risk of blood clots developing in your legs or lungs.

How you prepare

Exact preparations depend on which of your joints the surgeon is examining or repairing. In general, you should:

Avoid certain medications. Your doctor may want you to avoid taking medications or dietary supplements that can increase your risk of bleeding.

Fast beforehand. Depending on the type of anesthesia you'll have, your doctor may want you to avoid eating solid foods eight hours before your procedure.

Arrange for a ride. You won't be allowed to drive yourself home after the procedure, so make sure someone will be available to pick you up. If you live alone, ask someone to check on you that evening or, ideally, stay with you the rest of the day.

Choose loose clothing. Wear loose, comfortable clothing — baggy gym shorts, for example, if you're having knee arthroscopy — so you can dress easily after the procedure.

What you can expect

Although the experience varies depending on why you're having the procedure and which joint is involved, some aspects of arthroscopy are fairly standard.

You'll remove your street clothes and jewelry and put on a hospital gown or shorts.

A nurse will place an intravenous catheter in your hand or forearm and inject a mild sedative.

During the procedure

The type of anesthesia used varies by procedure.

Local anesthesia. Numbing agents are injected below the skin to block sensation in a limited area, such as your knee. You'll be awake during your arthroscopy, but the most you'll feel is pressure or a sensation of movement within the joint.

Regional anesthesia. The most common form of regional anesthesia is delivered through a small needle placed between two of your spine's lumbar vertebrae. This numbs the bottom half of your body, but you remain awake.

General anesthesia. Depending on the length of the operation, it may be better for you to be unconscious during the procedure. 

General anesthesia is delivered through a vein (intravenously).

You'll be placed in the best position for the procedure you're having. This may be on your back or on your side. The limb being worked on will be placed in a positioning device, and a tourniquet might be used to decrease blood loss and enhance visibility inside the joint.

Another technique to improve the view inside your joint involves filling the joint with a sterile fluid. This expands the area around the joint.

One small incision is made for the viewing device. Additional small incisions at different points around the joint allow the surgeon to insert surgical tools to grasp, cut, grind and provide suction as needed for joint repair.

Incisions will be small enough to be closed with one or two stitches, or with narrow strips of sterile adhesive tape.

After the procedure

Arthroscopic surgery usually doesn't take long. For example, arthroscopy of the knee takes about an hour. After that, you'll be taken to a separate room to recover for a few hours before going home.

Your aftercare may include:

Medications. Your doctor may prescribe medication to relieve pain and inflammation.

R.I.C.E. At home, may find it helpful to rest, ice, compress and elevate the joint for several days to reduce swelling and pain.

Protection. You might need to use temporary splints — slings or crutches for comfort and protection.

Exercises. Your doctor might prescribe physical therapy and rehabilitation to help strengthen your muscles and improve the function of your joint.

Call your surgeon if you develop:

A fever,  Pain not helped by medication,  Drainage from your incision,  Redness or swelling,  New numbness or tingling

Results

In general, you should be able to resume desk work and light activity in a few days. You'll likely be able to drive again in one to three weeks, and engage in more strenuous activity a few weeks after that.

However, not everyone's recovery is the same. Your situation might dictate a longer recovery period and rehabilitation.

Your surgeon will review the findings of the arthroscopy with you as soon as possible and may send a written report. Your surgeon will continue to monitor your progress in follow-up visits and address problems.

And Also:

Reasons for Arthroscopic Knee Surgery

Arthroscopic knee surgery may be a treatment option for certain types of knee pain. Arthroscopic surgery is a procedure that involves inserting a small camera inside the joint. Through other small incisions, instruments can be inserted to repair or remove damaged structures. Arthroscopic knee surgery is often called "scoping the knee" or knee arthroscopy.

Many different surgical procedures that are commonly performed arthroscopically were once performed through the larger incisions. The advantage of arthroscopy he is being able to perform those surgical procedures without damaging normal structures around the joint. By being less invasive, the hope is there will be less pain and a faster recovery.

However, arthroscopic surgery is still a major surgical procedure, involves risks, and requires appropriate postoperative rehabilitation. It is important that you understand the nature of any surgical procedure being considered, the risks involved, and the postoperative recovery that will be necessary to achieve a successful result.

Reasons to Perform Arthroscopic Knee Surgery

Not all causes of knee pain can be effectively treated with an arthroscopic procedure. Some of the reasons to perform an arthroscopic knee surgery include:

1:  Torn Cartilage/Meniscus Surgery: Meniscectomy is the official name of the surgery that involves the removal of a portion of the meniscus cartilage from the knee joint. The meniscus is a shock-absorbing wedge of cartilage that sits between the bone ends to provide cushioning and support. Smaller meniscus tears can usually be trimmed to relieve the symptoms of a torn meniscus.

Meniscus Repair: A meniscus repair is a surgical procedure done to repair the damaged meniscus. The meniscus repair can restore the normal anatomy of the knee and has a better long-term prognosis when successful. However, the meniscus repair is a more significant surgery. The recovery is longer, and, because of limited blood supply to the meniscus, repair of the meniscus is not always possible.

ACL Reconstruction: The anterior cruciate ligament, or ACL, is one of four major knee ligaments. The ACL is critical to knee stability, and people who injure their ACL often complain of their knee giving out from under them. Therefore, many patients who sustain an ACL tear opt to have surgical treatment of this injury. A majority of the ACL surgery is performed arthroscopically.

Plica Excision: A plica is a remnant of tissue left over from fetal development. In early development, your knee was divided into separate compartments. The dividers of the compartments are gradually lost over time, but some remnant remains. When this remnant tissue is more prominent, it is called a plica. When the plica is irritated, it is called plica syndrome. A plica resection is performed to remove this irritated tissue.

2:  Lateral Release: The kneecap moves up and down the end of the thigh bone in a groove of cartilage. The kneecap can be pulled to the outside of this groove, or may even dislocate from the groove, causing pain with bending of the knee joint. A lateral release is performed to loosen the ligaments that pull the kneecap toward the outside of the groove.

3:  Microfracture: Microfracture is a treatment used to stimulate the body to grow new cartilage in an area of damaged cartilage.

4:  In a microfracture procedure, the firm outer layer of bone is penetrated, to expose the inner layers of bone where marrow cells exist. These cells can then access the damaged area and fill in the gap of cartilage.

Autologous Chondrocyte Implantation: In this procedure, arthroscopic surgery is used to identify areas of cartilage damage and harvest cartilage cells.

5:  The person's own cells are then grown in the lab and reimplanted in the joint in a separate procedure, which is an open surgery rather than arthroscopic surgery.

Cartilage Transfer/OATS: Cartilage transfer involves moving cartilage from healthy parts of the joint to damaged areas. Small plugs of cartilage are removed, with a portion of underlying bone, and transferred to the area of damage. The plugs are taken from areas of the joint where the cartilage surface is not needed.

Performing Arthroscopic Knee Surgery

Knee arthroscopy can be done under general, regional, or local anesthesia. After adequate anesthesia, your surgeon will create 'portals' to gain access to the knee joint. The portals are placed in specific locations to minimize the potential for injury to surrounding nerves, blood vessels, and tendons. Through one portal, a camera is placed into the joint, and through others, small instruments can be used to address the problem. Patients who have arthroscopic knee surgery under a regional or local anesthesia can often watch their surgery on a monitor to see what is causing their problem.

The length of the knee arthroscopy procedure varies depending on what your doctor needs to accomplish. After surgery, your knee will be wrapped in a soft bandage. Depending on the type of surgery performed, your doctor may or may not allow you to place weight on the affected leg.

Most patients will work with a physical therapist to regain motion and strength of the joint. The length of rehabilitation will also vary depending on what procedure is performed at the time of surgery.

Complications

Complications of arthroscopic knee surgery include infection, swelling, and blood clots in the leg.

Complications are unusual after knee arthroscopy, and while they are cause for concern, knee arthroscopy is considered a low-risk surgical procedure.

A Final Word

Arthroscopic knee surgery is among the most common surgical procedures performed by an orthopedist. A variety of surgical procedures can be performed arthroscopically, utilizing small incisions and minimizing soft tissue damage. Not every surgical procedure can be performed through the small incisions, and there are some procedures that may be better performed through direct visualization rather than through a scope. That said, arthroscopy has tremendous benefits for many types of knee surgery, and can help people return to athletic and daily activities much sooner than they used to be able to.

Cancer And Radiation Treatment

What to know about radiation therapy?

What is it?

Side effects

Radiation and other treatments

Types

What to expect

Uses

Outlook

Radiation therapy is a treatment for cancer and, less commonly, thyroid disease, blood disorders, and noncancerous growths.

A doctor may recommend radiation for cancer at different stages. In the early stages, radiation therapy can help reduce the size of a tumor before surgery or kill remaining cancer cells afterward. In the later stages, it may help relieve pain as part of palliative care.

One form of radiation treatment involves using a machine that produces a beam of radiation. The beam targets a specific area of the body. Another type involves putting a radioactive substance inside the body, either permanently or temporarily.

In this article, we focus mainly on radiation therapy as a cancer treatment.

What is radiation therapy?

Technicians administer external beam radiation therapy using a linear accelerator.

Radiation therapy uses waves of energy, such as light or heat, to treat cancers and other tumors and conditions. The form of radiation used in cancer therapy is a high-energy type known as ionizing radiation.

Scientists still do not know exactly how radiation works as a treatment for cancer.

They do know, however, that it breaks up the DNA of cancer cells in a way that disrupts their growth and division. In this way, radiation can kill cancer cells, preventing or slowing the spread of the disease.

Sometimes a doctor prescribes radiation therapy alone, but usually, they recommend it in combination with other treatments, such as chemotherapy, surgery, or both.

Side effects

Radiation can affect healthy cells as well as cancerous ones. When this happens, a person experiences side effects.

Specific side effects depend on factors such as:

the area receiving treatment

the person’s overall health

the type and doses of radiation

Short term side effects

Short term side effects radiation therapy include fatigue, skin changes, and nausea.

Short term side effects vary, depending on the part of the body receiving radiation.

They can include:

fatigue

hair loss

diarrhea

skin changes

nausea and vomiting

A 2018 study published in BMJ Open recommends screening for anxiety and depression in people undergoing radiation therapy and offering counseling services to those who may benefit from them.

Long term side effects

Long term side effects also depend on the treatment site.

They include:

heart or lung problems, if radiation affects the chest

thyroid problems, leading to hormonal changes, if radiation affects the neck area

lymphedema, which involves lymph fluid building up and causing pain

hormonal changes, including a possibility of early menopause, from radiation in the pelvic area

There is a slight chance that high doses of radiation in certain areas can increase the risk of another form of cancer developing. A doctor will provide more specific information and help with weighing the risks and benefits.

Not everyone who has radiation therapy experiences long term side effects. The risk depends on the doses, the area of treatment, and other individual factors.

Radiation therapy and other treatments

Radiation therapy is one of several cancer treatments. A doctor may prescribe these separately or in combination.

As well as radiation, a person may have:

surgery

chemotherapy

hormone therapy

targeted therapy

The treatment plan will depend on the type of cancer, among other factors.

When a person receives radiation therapy and chemotherapy at the same time, the doctor may call this “chemoradiation.” It can lead to severe adverse effects.

When cancer is at an early stage, a person may have radiation therapy before surgery, to reduce the size of a tumor. Or, they may have it after surgery to help remove any remaining cancerous cells.

Radiation is only effective in targeted areas. It is less effective when cancer has spread to distant parts of the body.

Types

There are two forms of radiation therapy.

External beam radiation therapy

This is the most common type. It involves an external machine emitting a beam of radiation that targets the treatment area.

Different forms are available, depending on the need. High-energy beams, for example, can target cancer that is deeper within the body.

Internal radiation therapy

There are different types of internal radiation therapy. Both involve implanting or introducing a radioactive substance into the body.

Brachytherapy involves inserting a radioactive implant in or close to the cancerous tissue. The implant may be temporary or permanent. Another type of internal radiation therapy involves drinking or receiving an injection of radioactive liquid.

The goal is to limit the extent to which healthy tissue around the cancer is exposed to the radiation. Doctors may recommend this treatment for prostate or ovarian cancer, for example.

A doctor may recommend undergoing both main types of radiation therapy. The decision will depend on:

the type of cancer

the size of the tumor

the tumor’s location, including the types of tissue nearby

the person’s age and overall health

other treatments

Scientists continue to explore ways of improving radiation techniques to achieve more effective outcomes with the least possible risk.

What to expect

The doctor will discuss radiation therapy and other options and help weigh the pros and cons. Before treatment starts, they will determine the right type and dosage of radiation.

A person receiving external beam radiation may undergo a CT or MRI scan before treatment. This is to pinpoint the exact location and size of the tumor. A doctor may make a permanent but small mark on the skin to ensure that the radiation therapist will target the beam correctly.

A person may need to wear a plaster cast or use a headrest or another device to ensure that they stay still during treatment. The first session may be a simulation, in which the team runs through the procedure.

Many people have five sessions per week for 3–9 weeks, but this depends on specific factors. Each session lasts for around 15 minutes. Radiation therapy is painless, but there will be damage to surrounding tissue. This is why the treatment occurs on only 5 days per week. The 2-day break allows for some healing.

A person who has internal radiation therapy may require an anesthetic before the doctor can implant the radioactive substance. Overall, several sessions and some time in the hospital may be necessary.

The details of the process depend on the type of radiation therapy and the type and location of the cancer.

Aftercare

After receiving external treatment, a person can go home and continue with their daily routine.

However, they may experience:

tiredness

sensitivity around the treatment site

emotional distress

To help manage these effects, it is important to:

get plenty of rest

eat healthfully

talk to friends and family about any side effects

follow instructions, which may involve skin care, from the treatment team

avoid spending time in the sun, due to a risk of photosensitivity

Also, monitor for adverse effects and tell the doctor if they occur. The doctor may recommend additional treatments aimed at relieving these.

People may need to speak to their employers about adjusting work schedules or taking medical leave.

Uses

A doctor may recommend radiation therapy to kill cancerous cells.

Radiation therapy can help shrink tumors and kill cancerous cells in the early stages.

This kind of treatment, in combination with other appropriate therapies, can cause cancer to go into remission. In many cases, it does not come back again.

Radiation therapy can also help treat symptoms when cancer has spread widely. At this point, the radiation is part of palliative care, which aims to relieve a person’s symptoms and improve their quality of life. It may also extend a person’s life, in some cases.

Palliative radiation treatment usually involves lower doses and fewer treatment sessions than curative treatment.

In some people with bone cancer, for example, palliative radiation treatment can help stop painful tumors from developing.

Other ways that palliative radiation treatment can help include:

relieving pressure or a blockage by reducing tumor size

treating symptoms of brain cancer, such as headaches, nausea, and dizziness

reducing symptoms of lung cancer, such as chest pain and breathlessness

controlling ulcerating tumors, bleeding, and infections

In people with head and neck cancers, an obstruction in the superior vena cava can affect the return of blood to the heart. Radiation therapy can help relieve this.

Outlook

Some people feel anxiety and concern about radiation therapy. It has various uses in treating cancer, and it can help achieve complete remission, in some cases.

The National Cancer Institute (NCI) points out that radiation can be costly.

People with health insurance should speak with their provider about coverage. Also, some organizations provide financial support and other help to people who need treatment. The NCI provide a list of options.

Discuss any concerns with the doctor and ask as many questions as possible. Knowing what to expect can help.

Q:

Will my hair grow back after radiation therapy?

A:

Radiation therapy only causes hair loss at the site receiving the therapy. Hair loss may be temporary or permanent, depending on the site and the doses. Higher doses of radiation may be more likely to result in permanent hair loss.

And Also:

What Can One Expect During Treatment

It is normal to feel worried or overwhelmed when you learn that you will need radiation therapy. However, learning more about this type of cancer treatment may help you feel more prepared and comfortable. The information in this article can help you prepare for your first treatment.

Who is on my radiation therapy team?

A highly trained medical team will work together to provide you with the best possible care. This team may include the following health care professionals:

Radiation oncologist. This type of doctor specializes in giving radiation therapy to treat cancer. A radiation oncologist oversees radiation therapy treatments. They work closely with other team members to develop the treatment plan.

Radiation oncology nurse. This nurse specializes in caring for people receiving radiation therapy. A radiation oncology nurse plays many roles, including:

Answering questions about treatments

Monitoring your health during treatment

Helping you manage side effects of treatment

Medical radiation physicist. This professional helps design treatment plans. They are experts at using radiation equipment.

Dosimetrist. The dosimetrist helps your radiation oncologist calculate the right dose of radiation.

Radiation therapist or radiation therapy technologist. This professional operates the treatment machines and gives people their scheduled treatments.

Other health care professionals. Additional team members may help care for physical, emotional, and social needs during radiation therapy. These professionals include:

Social workers

Nutritionists or dietitians

Rehabilitation therapists, such as physical therapists or speech therapists

Dentists

What happens before radiation therapy treatment?

Each treatment plan is created to meet a patient's individual needs, but there are some general steps. You can expect these steps before beginning treatment:

Meeting with your radiation oncologist. The doctor will review your medical records, perform a physical exam, and recommend tests. You will also learn about the potential risks and benefits of radiation therapy. This is a great time to ask any questions or share concerns you may have.

Giving permission for radiation therapy. If you choose to receive radiation therapy, your health care team will ask you to sign an "informed consent" form. Signing the document means:

Your team gave you information about your treatment options.

You choose to have radiation therapy.

You give permission for the health care professionals to deliver the treatment.

You understand the treatment is not guaranteed to give the intended results.

Simulating and planning treatment. Your first radiation therapy session is a simulation. This means it is a practice run without giving radiation therapy. Your team will use imaging scans to identify the tumor location. These may include:

A computed tomography (CT) scan

Magnetic resonance imaging (MRI)

An x-ray

Depending on the area being treated, you may receive a small mark on your skin. This will help your team aim the radiation beam at the tumor.

You may also be fitted for an immobilization device. This could include using:

Tape,  Foam sponges,  Headrests,  Molds,  Plaster casts

These items help you stay in the same position throughout treatment.

For radiation therapy to the head or neck, you may receive a thermoplastic mask. This is a mesh mask that is molded to your face and secured to the table. It gently holds your head in place.

It is important for your body to be in the same position for each treatment. Your radiation oncology team cares about your comfort. Talk with the team to find a comfortable position that you can be in every time you come in for radiation therapy. Tell them if you experience anxiety lying still in an immobilization device. Your doctor can prescribe medication to help you relax.

After the simulation at your first session, your radiation therapy team will review your information and design a treatment plan. Computer software helps the team develop the plan.

What happens during radiation therapy treatment?

What happens during your radiation therapy treatment depends on the kind of radiation therapy you receive.

External-beam radiation therapy

External-beam radiation therapy delivers radiation from a machine outside the body. It is the most common radiation therapy treatment for cancer.

Each session is quick, lasting about 15 minutes. Radiation does not hurt, sting, or burn when it enters the body. You will hear clicking or buzzing throughout the treatment and there may be a smell from the machine. Typically, people have treatment sessions 5 times per week, Monday through Friday. This schedule usually continues for 3 to 9 weeks, depending on your personal treatment plan.

This type of radiation therapy targets only the tumor. But it will affect some healthy tissue surrounding the tumor. While most people feel no pain when each treatment is being delivered, effects of treatment slowly build up over time and may include discomfort, skin changes, or other side effects, depending on where in the body treatment is being delivered. The 2-day break in treatment each week allows your body some time to repair this damage. Some of the effects may not go away until the treatment period is completed. Let the health care professionals if you are experiencing side effects. Read more about the side effects of radiation therapy.

Internal radiation therapy

Internal radiation therapy is also called brachytherapy. This includes both temporary and permanent placement of radioactive sources at the site of the tumor.

Typically, you will have repeated treatments across a number of days and weeks. These treatments may require a brief hospital stay. You may need anesthesia to block the awareness of pain while the radioactive sources are placed in the body. Most people feel little to no discomfort during this treatment. But some may experience weakness or nausea from the anesthesia.

You will need to take precautions to protect others from radiation exposure. Your radiation therapy team will provide these instructions. The need for such precautions ends when:

The permanent implant loses it radioactivity

The temporary implant is removed

Weekly reports

During your treatment, your radiation oncologist will check how well it is working. Typically, this will happen at least once a week. If needed, they may adjust your treatment plan.

Personal care

Many people experience fatigue, sensitive skin at the site of radiation exposure, and emotional distress during radiation therapy. It is important to rest and take care of yourself during radiation therapy. Consider these ways to care of yourself:

Plan for extra rest.

Eat a balanced diet.

Drink liquids regularly.

Treat affected skin with lotion approved by your health care team.

Protect your affected skin from sunlight.

Seek emotional support.

Learn more about coping during treatment. And, be sure to talk with your health care team about how you are feeling throughout your treatment period.

What happens after radiation therapy treatment ends?

Once treatment ends, you will have follow-up appointments with the radiation oncologist. It's important to continue your follow-up care, which includes:

Checking on your recovery

Watching for treatment side effects, which may not happen right away

As your body heals, you will need fewer follow-up visits. Ask your doctor for a written record of your treatment. This is a helpful resource as you manage your long-term health care.

Questions to ask the health care team

Who is creating my radiation therapy treatment plan? How often will the plan be reviewed?

Which health care professionals will I see at every treatment session?

Can you describe what my first session, or simulation, will be like?

Will I need any tests or scans before treatment begins?

Will my skin be marked as part of treatment planning?

Who can I talk with if I'm feeling anxious or upset about having this treatment?

How long will each treatment session take? How often will I have radiation therapy?

Can I bring someone with me to each session?

Are there special services for patients receiving radiation therapy, such as certain parking spaces or parking rates?

Who should I talk with about any side effects I experience?

Which lotions do you recommend for skin-related side effects? When should I apply it?

How else can I take care of myself during the treatment period?

Will special precautions be needed to protect my family and others from radiation exposure during my treatment period?

What will my follow-up care schedule be?