Understanding Cancer Treatment Options: Radiation Therapy

Radiation therapy is the use of ionizing radiation—X-rays, gamma rays, or subatomic particles such as neutrons—to destroy cancer cells. Learn how it works, the types of radiation, and early and late side effects you may see. https://bit.ly/4cEClyU

In this Episode:

• 01:52 - Road Trip - Louisiana, and Crunch Cake Recipe
• 03:30 - Anna Quindlin - The Dividing Line
• 06:52 - Radiation Therapy Explained
• 12:16 - Radiation Side Effects
• 17:35 - Late Effects of Radiation Therapy
• 20:54 - Discussion - Not Being Able to Swallow
• 26:06 - The Mole Agent and The Man on the Inside
• 30:48 - Outro

Related Content:

• S6E2: Understanding Cancer Treatment Options: Surgery
• S5E52: Cancer Gone Wild – Learn All About Metastasis
• S5E45: Why Does Cancer Exist? Empower Yourself With Understanding
• S5E46: “Why Do I Have Cancer?” Kismet, Chastisement or Coincidence?
• S5E47: MythBusters – Cancer Edition; Clarifying Common Cancer Myths & Misconceptions
• S5E48: How to Read a CT Scan Report – Learn the Sections Relevant to Your Diagnosis
• S5E49: Are there Miracle Cures for Cancer? With Dr. Jeanna Ford
• S5E50: What is Meant by Cancer Staging? Learn the Language of a Cancer Diagnosis

Chapters

• 0:00 Intro
• 1:52 Road Trip – Louisiana, and Crunch Cake Recipe
• 3:30 Anna Quindlin – The Dividing Line
• 6:52 Radiation Therapy Explained
• 12:16 Radiation Side Effects
• 17:35 Late Effects of Radiation Therapy
• 20:54 Discussion – Not Being Able to Swallow
• 26:06 The Mole Agent and The Man on the Inside
• 30:48 Outro

Transcript

Hello, and welcome to Everyone Dies, the podcast where we talk about serious illness, dying, death, and bereavement. I'm Marianne Matzo, a nurse practitioner, and I use my experience from working as a nurse for 47 years to help answer your questions about what happens at the end of life. And I'm Charlie Navarette, an actor in New York City, and here to offer an every person viewpoint to our podcast.

We are both here because we believe that the more you know, the better prepared you are to make difficult decisions in a crisis. Also, this podcast does not provide medical nor legal advice. Please listen to the complete disclosure at the end of the recording.

Welcome to this week's show. We're so glad to have you join Charlie and me for the next hour as we continue with our series titled, Everything You Always Wanted to Know About Cancer, But Didn't Have Anyone to Ask. With a conversation about treatment options, specifically radiation therapy.

This podcast is a combination of education and entertainment, edutainment, if you will, delivered in three halves. Our main topic is in the second half, so you can fast forward to that yackety-yack free zone if you'd like. In the first half, Charlie has our recipe of the week and an excerpt from Anna Quinlan's A Short Guide to a Happy Life.

In the second half, I'm going to talk about ways that we treat cancer with a specific focus on radiation therapy this week. In the third half, Charlie talks about the documentary, The Mole Agent, and it's not about a rodent, is it Charlie? It's not, I had the wrong script. Oh, wait a minute, yeah, right, it's not.

It's not about little rodents. And in this week, it's Louisiana, which is where our travels take us to where Mardi Gras began in 1699 as a Catholic festival and grew into a major national holiday that attracts one and a half million visitors a year to New Orleans. Louisiana is the only state with a large population of Cajuns, descendants of the Acadians who were driven out of Canada in the 1700s because they wouldn't pledge allegiance to the King of England.

Voodoo is widely practiced in New Orleans. Early proponents included migrants from the Haiti Slave Revolt of 1791 and freed people of color from West Africa. They merged their religious rituals with local Catholic practices.

Voodoo kings and queens were powerful political figures in the city during the 1800s. There's also a group of about 50 vampires that live in New Orleans. They have a unique lifestyle.

That includes the practice of consuming human blood from people who are willing donors. In most cases, these members of the vampire community have sharpened their teeth into specialized fangs to resemble those commonly seen in popular culture. Our recipe this week is a true Southern delight.

Louisiana crunch cake is buttery and sweet with a layered flavor profile that includes coconut, vanilla, and divinely sweet clays. Caramelized sugar along the crust elevates the flavor and texture and the coconut garnish adds a nice pop of color. Perfect for your next funeral repast.

Bon appetit. Now for something completely different. I have an excerpt from the book, A Short Guide to a Happy Life by Anna Quindlen, the bestselling novelist and columnist.

In it, she reflects on what it takes to get a life, to live deeply every day and from your own unique self rather than to merely exist through your days. Maybe you've come to feel the way I have and you've come to feel that way for a very difficult or demanding reason. One day you were walking around worrying about whether you had anything to wear to a party and reminding yourself to buy kitty litter or toilet paper.

And then you were in the shower lathering up or you were lying on a doctor's table where the phone rang and your world suddenly divided as my world did many years ago. It divided into before and after. Before for me was my freshman year of college when I found myself able for the first time in my life to swear at meals and not be reprimanded, to go out at midnight and not have to tell anyone where I was going.

After was the beginning of what would have been my sophomore year when I found myself out of school making meatloaf and administering morphine in a development house in the suburbs. It is amazing how much you can learn in one year, just like Paul who was knocked off his mule into the dust on the way to Damascus and discovered God. I had a rude awakening.

I'm not sure I learned anything much about mortality or death or pain or even love. Although in the years since, I found that that one horrible year has given me a perspective on all those things I wouldn't otherwise have had. Before and after for me was not just before my mother's illness and after her death.

It was a dividing line between seeing the world in black and white and in technicolor. The lights came on for the darkest possible reason. And I went back to school and I looked around at all the kids I knew who found it kind of a drag and weren't sure if they really could hack it and who thought life was a bummer.

And I know that I had undergone a sea change because I was never again going to be able to see life as anything except a great gift. Please go to our webpage for this week's recipe for Louisiana Crunch Cake and additional resources for this program. Everyone Dies is offered at no cost but is not free to produce.

We count on you to contribute. Your tax deductible gift will go directly to supporting our nonprofit journalism so that we can remain accessible to everyone. You can also donate at www.everyonedies.org or at our site on Patreon and search for Everyone Dies.

Marianne. Thank you, Charlie. Radiation therapy is the use of ionizing radiation, x-rays, gamma rays or subatomic particles such as neutrons to destroy cancer cells.

Approximately 50% of all individuals diagnosed with cancer receive radiation therapy and this treatment is second only to surgery. Cancer cells are more sensitive to radiation than healthy cells because they are endlessly multiplying, making them less able to recover from radiation damage than normal cells. Thing is, normal cells don't reproduce as fast as cancer cells.

Radiation destroys cancer cells from genetic damage, making them unable to reproduce. Remember, cancer starts because of errors in cell reproduction. So there is some poetic justice here.

The second way radiation destroys cancer cells is because the radiation starts the process of apoptosis, which is a programmed cell death. Different ranges or voltages of radiation are used. The lowest range is superficial radiation.

The medium range is ortho voltage and the high range is super voltage. The techniques used to deliver radiation therapy are brachytherapy and teletherapy. Now brachytherapy, which is also called internal radiation therapy is a kind of radiation that's placed directly into the tumor or within a nearby body cavity.

Some of the substances used are radioactive isotopes of iridium, cesium, gold, and iodine. The devices used to contain the radioactive substances are tubes, needles, grains, and wires. Sometimes the radioactive source is delivered to the tumor through tubes and then withdrawn.

An approach called remote brachytherapy. Teletherapy or external radiation therapy uses a device such as a clinical linear accelerator to deliver ortho voltage or super voltage radiation at a distance from the patient. The energy beam can be changed to adjust the dose delivery to the volume of tissue that's being irradiated.

Radiation is administered in repeated small doses called fractions. This is done to reduce complication and when given at equal doses allows for more effective cure. For some tumors, including cancer of the uterus, cervix, larynx, throat, breast, and prostate, as well as Hodgkin's disease and some types of testicular cancer, curative doses of radiation can be applied without serious damage to surrounding tissues.

Before external beam radiation begins, a series of pretreatment procedures are needed. First, the precise location of the tumor is identified by an MRI. Next, the appropriate energy level of radiation is selected and the beam and dose distribution are carefully determined to make the best use of the therapeutic effect and minimize damage to healthy tissues.

Precise irradiation requires devices, usually like a cast, that carefully positions the patients. Sometimes markings are used to position and define the treatment area. Radiation therapy is often combined with surgery.

Although surgery is the most useful in removing a localized tumor, it may not be able to remove cells that have spread beyond the margins of the surgical procedure. You may have heard people say after surgery that they had clean margins. And what this means is the surgeon was able to get to the tumor so that all that was left was healthy or non-cancerous tissue.

If they were unable to get clean margins in surgery, radiation may be ordered. Radiation therapy is effective at destroying undetected cancer at the edges of a tumor and least effective in killing cells at the center of large tumors. So let's say a woman has surgery for the limited removal of a breast tumor, which is called a lumpectomy, and followed by radiation therapy.

What we're doing is taking advantage of the strengths of both surgery and radiation. Surgery to cut out the cancer and the radiation to destroy anything that remains on the edges. In the case of brain cancer, radiosurgery is considered a valid alternative to surgery.

In this approach, very high doses of radiation are delivered to a precisely defined volume of tissue in a short period of time, effectively killing tumors and reducing the size of the tumor mass. I've had many patients tell me how glad they are that they, quote, only need surgery and radiation, which makes me think that films and TV shows have really not shown the difficulties of radiation therapy as effectively as we have those of chemotherapy. Radiation therapy is not an easy treatment and has many side effects that seem to take people by surprise.

The side effects of radiation therapy are divided into acute and late effects. Acute effects are those that happen during the time of receiving radiation therapy. Just about everyone will experience tiredness and sore, dry, or itchy skin in the areas that were treated.

Any area that has rapidly renewing tissues, such as the lining of the mouth, the throat, intestines, bladder, and vagina are going to be sensitive to radiation and likely to have side effects. The side effects that a person has are related to the area that is radiated. When presented with the consent for radiation, it's my experience that people really don't pay a lot of attention to the discussion about the side effects.

It's reasonable to think, I'm gonna just focus on killing this cancer and I'm gonna deal with the rest later. But then I see them when the side effects kick in and they are generally pretty surprised by them. So I just wanna remind you, there are no rewards for being tough.

And be sure to tell your healthcare practitioner what you are experiencing so they can help you and prevent problems that you might not even know could happen. My sister had her cancer metastasized to the side of her throat, though it was called the paratracheal space. So it was just like outside the trachea, but it pushed on her trachea.

And as a result, she was unable to swallow. But she didn't wanna mention it. She said, you know, you can tell them when you come.

Now, mind you, at the time, I lived a thousand miles away and had two kids under three. So I drove with her to her appointment and when the practitioner asked if she could still drink, my sister said yes. And then the practitioner moved on.

And I stopped and I said, Joan, tell them what happens to the liquid when you drink. And she said, oh, I spit it out. And the practitioner looks at my sister and looks at me.

It's like, oh God. So I said, you know, her blood pressure is low. Her pulse is fast.

She hasn't been able to swallow in days. Can we maybe talk about a feeding tube? Needless to say, they started an IV. Drew labs, got in a feeding tube that very day.

So I tell you this just so that you can be honest with the professionals who are caring for you. There are no awards for toughing it out. And in fact, you could end up losing your life because of a side effect that would have easily been fixed.

So let's go over what might be expected in terms of different types of radiation. Remember that side effects only occur in the area that has had radiation therapy. So if you have radiation to your chest, the main side effects from chest radiation are difficulty swallowing, nausea and vomiting, weight loss, trouble breathing, swelling of the lymph nodes, hair loss, and heart problems.

Brain radiation has symptoms of feeling sick to the stomach, trouble with memory or concentration, nausea and vomiting, skin changes, headache, blurry vision, or hair loss. Head and neck radiation, the side effects you'll see are mouth soreness, changes in taste, weight loss, difficulty swallowing, changes in voice, swelling of lymph nodes at the neck and face, hair loss, and damage to the teeth. This damage to the teeth is a result of damage to the skin inside the mouth, which results in making less saliva, spit, and changes in the environment in the mouth called altered oral flora, which can lead to cavities, dental decay, enamel destruction, and sensitivity to the teeth.

And abdominal or radiation therapy can lead to diarrhea, nausea and vomiting, weight loss, urinary and bladder problems, hair loss, and pain. There can also be more general side effects such as sore skin, tiredness, and changes to your sex life and fertility. Now late changes to radiation therapy are those that are related to the total dose of radiation received and can take months or even years to develop.

These are cavities and tooth decay, early menopause, heart, lung, or thyroid disease. I have two friends right now that have undergone radiation therapy for actually totally different types of cancer. And one has had two heart valve replacements so far and needs a third.

And the other is in not complete, but very severe heart problems so that he can no longer work and has trouble carrying out activities. And so their cancer is controlled, but they're now dealing with heart issues because of their treatment. There can be an increased risk of other cancers.

I have two other friends who have skin cancer as a result of their radiation treatments from 10, 15 years ago. There's an increased risk of stroke, infertility, intestinal problems in terms of like diarrhea, that kind of thing. Swelling of the lymph nodes and the tissues in the area, memory issues, osteoporosis.

That's when the calcium kind of leeches out of your bones and people will get shorter because their bones in their spine are kind of compressing. And also you are at increased risk for bones anywhere breaking. Scar formation, fibrosis.

And you think, oh, well, I can deal with that. Except if the fibrosis is in the areas where, like in your gut where you've had surgery, then fibrosis can make it difficult for stool to move through. And sometimes people will get blockages that really can be life-threatening.

And lastly, creation of abnormal openings. They're called fistulas where there's an opening between two organs that shouldn't be there and that can cause problems, which is an understated way of saying that could be a problem. So secondary effects tend to be less significant in brachytherapy.

That's that internal radiation therapy compared to the teletherapy, the external radiation therapy. As part of this cancer series, we will have individual shows about side effects and how to deal with them. But if you need that information right now, I put quite a few resources in the show notes and click on them and get information about how to manage symptoms or talk to your oncologist, ask for a referral to palliative care and palliative care will manage those symptoms for you.

And you'll be glad you did. Next week, we will be talking about chemotherapy. So stay tuned for that discussion.

Charlie, do you have any questions about radiation therapy? The, what you mentioned about not being able to swallow, I don't get that. If you can't swallow, how, yeah, how do you, well, drink water. How do you, you know, have a piece of toast? I don't understand that.

Well, you don't have a piece of toast. You can swish water around in your mouth, but what we can do is we can put a tube into your stomach and bypass the throat entirely. And you can either blend your meals so that they're watery enough to get in through the tube, or we have special tube feedings that can just get poured directly right in.

I mean, just a sensation that you can't swallow. You need your throat to swallow, to get food down to your stomach. And you need, it sort of shares a passageway in terms of air going down.

And so you can, we can surgically bypass both of those things. We could put a trach in your throat so that air could, Charlie, we've talked about this. Don't make those noises.

That you can put a trach in your throat so that air can get in, and we can put a tube in your stomach so that food and fluids could get in. So biologically, you don't have to swallow in order to survive. I think what you're referring to is that the physical pleasure of eating or the sensation of having food or having wine or having your martini in your throat.

And I've talked before about going out with my sister and getting White Castles. And she ate, she chewed it, and she had to spit it out because she couldn't swallow it. She could have the taste sensation.

She could have the smell sensation. She could have the community sensation of, I was gobbling my White Castle, and she was just having all those other sensations. The liquid that your mouth just naturally produces that we swallow all the time, we don't think about it.

We got a little, a suction catheter so that when it builds up, whatever she couldn't swallow to get past that tumor, she would suck out of her mouth. So, and she was willing to do that because her daughter was pregnant and she wanted to live long enough to see her grandchild. Now, there are other people who will say, if I can't swallow on my own and this cancer is limiting my life and I've only got weeks or months to live, then I'm perfectly fine with no artificial food and fluids, which is when you're putting a tube in somebody's stomach or dropping a tube down their nose in order to bypass, to take artificial, artificial food, it's the stuff in the cans.

Some people say, I don't wanna do that. And I'll just allow natural death and I'll go when I'm supposed to go without any interventions. And both are reasonable options depending on what your goal is.

No, it was just simply just a sensation of not being able, I hear what you're saying about taste and all that. No, that wasn't it. I just can't imagine not being able to swallow at all.

And I can't imagine that sensation. Well, I've taken care of many patients who can't, but I guess what I'm saying is that if it's a choice of bypassing that for whatever reason and just saying, I don't wanna live if I can't swallow or I don't wanna live doing all the things I have to do if I can't swallow, then like I said, I think both are reasonable options. And I appreciate what you're saying that you can't imagine it, but I've taken care of so many patients that are in situations that they can't imagine ever seeing themselves in and yet here they are.

Okay, in our third half, The Mole Agent is a documentary from Chile. The story is about Sergio, an 83 year old man who was hired by a private investigator to go undercover in a nursing home to confirm whether a client's grandmother is being mistreated. Not to be outdone, Netflix has released a man on the inside.

The story of a 77 year old man played by Ted Danson hired as a private investigator to find out who stole a client grandmother's necklace. The New York Times tells us that ultimately what makes Charles and Sergio come out of their shells is they meet people as something to offer them as they unknowingly have something to offer them. Sergio struggles to balance his assignment with his increasing involvement in the lives of several residents, most of whom are women and see him as catnip.

The focus turns to an unexpected human side of the mission, the effects of aging, loneliness and the need for intimacy. The investigation of the staff and discovery of any mistreatment fades. Sergio, assigned to gathering evidence, becomes a confidant and friend to the residents.

Similarly, CEO Today Magazine explains that retired engineering professor Charles Niewendik, played by Ted Danson in A Man on the Inside, is a widower struggling with grief who spends much of his time in isolation after the death of his wife. Daughter Emily, worried about his growing loneliness, encourages him to break out of his comfort zone. This prompts him to answer an ad posted by a private investigator to go undercover in a retirement community to investigate the theft of a necklace, later followed by suspicions of mistreatment of the more elderly residents.

Charles befriends various residents to find the missing jewelry, but as he winds his way around the home, he begins to notice residents' isolation and a lack of connection among people. Breaking down emotional barriers gives him direction to the detriment of finding the thief. It also eventually forces him to reconnect with his emotions, begin to heal from loss and learn to open up to others.

Not meaning to, he creates meaningful connections. On par with her father, daughter Emily struggles to find balance between caring for her father and her own emotional journey as Charles discovers the missing jewel. An unexpected treat is a number of supporting actors.

Sally Struthers from All in a Family, along with veteran actors Margaret Avery, John Goetz, Veronica Cartwright, and Stephen McKinley Henderson. Names you might not recognize, but when you see them, you may say out loud, I thought they were dead, as mortality stares back and we blink. What part did Sally Struthers have? She, well, I mean, she was one of the residents and she was one of the people who looked at Danson's character as catnip.

Many of the ladies were attracted to him. Well, I saw the show, but I'm trying to, like. Oh, oh, oh, the, how did I? John Goetz played her jealous boyfriend.

That was Sally Struthers? That's Sally, you know, yes, Sally Struthers. Holy schmoly. Yeah, that's her.

Oh my God, how did I miss her? Well, I mean, she, I mean, I saw the resemblance from her and, you know, when she was in All in the Family, but yeah, I mean, she really, I mean, she's done various things in her life, but, you know, the last big thing was All in the Family in the 1970s. Yeah, but then you also saw her, like, doing those ads for, was it Hunger and Feed the Poor or something? What was that? So, I mean, I've seen her a lot. I just was, I'm just, as you can tell, truly stunned that I didn't recognize her.

Yep, that's her. Good Lord, good Lord, Charles. Time flies.

Yeah. And with that, please stay tuned for the continuing saga of Everyone Dies, and thank you for listening. This is Charlie Navarette.

And from Dick the Butcher in Shakespeare's Henry VI, part two, the first thing we do, let's kill all the lawyers. And I'm Marian Matso, and we'll see you next week. Remember, every day is a gift.

This podcast does not provide medical advice. All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages, and any other discussion are for informational purposes only. And are not a substitute for professional medical advice or treatment.

Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health. Never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast. If you think you may have a medical emergency, call your doctor or 911 immediately.

Everyone Dies does not recommend or endorse any specific tests, practitioners, products, procedures, opinions, or other information that may be mentioned in this podcast. Reliance on any information provided in this podcast by persons appearing on this podcast at the invitation of Everyone Dies or by other members is solely at your own risk.