RespiteMatch.com Health Blog

If you’ve ever been to the dentist or been treated for a broken bone, you’ve experienced radiation firsthand. In everyday life, radiation in the form of X-rays is used to create images of areas of the body that doctors can’t see, such as the inside of a tooth or the interior of the chest cavity. But in much higher doses, radiation can be used to treat cancer and other illnesses by not only preventing cells from growing or reproducing, but eventually destroying them.

Also called radiotherapy, irradiation, or X-ray therapy, radiation therapy is one of the most common forms of treatment for cancer. According to the National Cancer Institute, more than half of all people with cancer undergo some form of radiation therapy during treatment. If your child is one of them, keep reading for more information about this potentially life-saving treatment for kids with cancer.

What Is Radiation Therapy?
In radiation therapy, high-energy radiation from X-rays, gamma rays, or other sources is used to kill cancer cells and shrink tumors. Some types of childhood cancer treated with radiation therapy include brain tumors, Wilms’ tumor, and head and neck cancers.

Although the goal of radiation therapy is to destroy cancer cells, it can also be harmful to normal cells. The good news? Normal cells are more likely to recover from the effects of radiation. In radiation therapy, doctors and nurses take extensive measures to carefully monitor radiation doses to protect your child’s healthy tissue.

Because each child’s situation is different, each child’s cancer treatment is individualized and unique. Some kids receive only radiation therapy to treat their cancer. Other children need both radiation and chemotherapy, the use of medicines to destroy cancer cells. And some children require radiation therapy and surgery to remove tumors or cancerous areas.

How Is Radiation Given?
Radiation therapy is administered two ways: externally or internally. Some children may receive both external and internal radiation, depending on the child’s needs.

External radiation therapy uses a large machine and special equipment that aims very specific amounts of radiation at cancerous tumors or diseased areas of the body. A child who receives internal radiation therapy (also known as brachytherapy, interstitial therapy, or implant therapy) may have a radioactive substance injected or implanted into the body at the site of the tumor or cancer cells. In some cases, a child may swallow a radioactive material. Generally, children receive only external radiation therapy, although kids and teens who have cancers of the head and neck, uterus, cervix, thyroid, and testes may be treated with internal radiation therapy.

A radiation oncologist, a doctor who specializes in radiation therapy, will work with other health care professionals to decide on the type and dose of radiation therapy that’s best to cure your child’s cancer.

What Happens During Radiation Therapy?
Receiving radiation therapy for cancer treatment isn’t a one-time deal: Children and teens who receive external radiation usually visit the hospital or treatment center on an outpatient basis 4 to 5 days a week for several weeks, coming in just for the treatment and going home right after. Receiving small daily doses of radiation helps to protect the normal cells from damage, and weekend breaks help the normal cells to recover from the trauma of radiation.

Before the first radiation therapy treatment, a planning session takes place. This process is called simulation. The child lies on an X-ray table, while a radiation therapist uses a special X-ray machine (called a simulator) to define the treatment area. Some X-rays or CT scans might be taken, and an area on the skin is marked with ink to highlight the area to be treated. This “tattoo” should not be wiped off, because these spots help to position the radiation for each treatment. At each external radiation appointment, the child dresses in a hospital gown or robe and enters the radiation treatment room. After the radiation therapist settles the child into position and leaves the room, a large machine delivers the exact amount of radiation necessary to kill the cells in the cancerous area. Most of the time that the patient spends on the radiation treatment table during each visit involves the verification of proper patient positioning - the treatment itself takes only minutes.

Younger children may find it difficult to remain still during the few minutes of treatment. Parents aren’t allowed in the treatment room to prevent unnecessary radiation exposure, but other steps can be taken to comfort children undergoing therapy. Some hospitals may provide body molds to help immobilize your child during therapy; others may provide two-way communication devices so you can talk with and reassure your child during treatment. Some treatment centers even provide closed-circuit televisions that allow you to watch your child during the procedure. Some children may need to be sedated or anesthetized so they will remain motionless during the few minutes of treatment.

Children and teens who receive internal radiation treatment usually need to remain in the hospital for several days so they can be carefully monitored by the hospital staff. The radioactive material may be placed in small tubes, which are implanted into the cancerous tumor or a body cavity, or the material may be swallowed or injected into the person’s bloodstream. This can sometimes be a minor surgical procedure which requires anesthesia (for example, when inserting something into the uterus, esophagus, or airways in the lungs).

If your child is receiving radiation therapy, you may be wondering whether the radiation will rub off on you or other family members - and whether you’ll be able to touch, hug, and care for your child during and after treatment. If your child is having only external radiation therapy, there’s no need to worry. Children who receive external radiation are not radioactive after treatment, so contact with family members does not need to be restricted in any way.

For kids and teens receiving internal radiation therapy, it’s a different situation - and there may be some restrictions. That’s because the radiation in the implant may send high-energy rays outside the child’s body, so visitors will need to be protected from exposure to radiation. The hospital or treatment center will place the child in a private room, and nurses and visitors will not be able to spend long periods of time with the child. Your child will have all the necessary care, but the nurses will work quickly to reduce exposure.

What Are the Common Side Effects of Radiation?
As the parent of a child with cancer, you’re not only coming to terms with your child’s diagnosis - you may also be worried about how radiation therapy treatment will affect your child physically and emotionally.

Although the main purpose of radiation is to destroy cancer cells, it can also damage healthy cells. It’s this damage to normal cells that results in radiation side effects, most of which are related to the area being treated. The physical side effects a child experiences from radiation therapy depend on the dose of radiation, the location where the radiation was received, and whether the radiation was internal or external. Many patients have no side effects at all, but for those who do, most effects go away in time, generally aren’t serious, and can be controlled with proper treatment.

A child who receives radiation therapy may experience side effects shortly after beginning treatment (called early side effects), such as:

Fatigue
One of the most common side effects of radiation treatment, both during treatment and after, fatigue often begins within a few weeks after treatment starts and commonly lasts until 4 to 6 weeks after treatment is completed. Encourage your child to rest and sleep as often as possible, even if resting or sleeping doesn’t immediately result in more energy. In the long run, rest helps the body recover from radiation treatment.

Skin Damage or Changes
Skin damage is another very common side effect of radiation treatment, but only in the area receiving the radiation dose. The skin in the treatment area may be red, sensitive, or easily irritated in the days, weeks, and months during and after treatment. The skin may swell or droop or the texture may change. Although the skin irritation should go away within 2 to 3 weeks after treatment ends, your child’s skin may be darker. Also, the area of skin that received the radiation therapy may be more sensitive to sun exposure for months after treatment. There may also be some permanent skin changes to the color and elasticity of the skin.

How can you help your child? Dress him or her in loose-fitting, soft clothes (such as cotton fabrics) to avoid skin irritation in the treatment area. It’s also important to protect the delicate skin from sunlight. During the course of treatment, the irradiated skin should not be exposed to sunlight. After treatment, you should always apply a sunblock with a sun protection factor (SPF) of at least 15 on the affected area.

When it comes to caring for your child’s skin, gentleness is key. Be careful not to irritate the treated skin, and wash it gently with only lukewarm water and mild soap. Avoid rubbing and scrubbing the skin; simply pat it dry after bathing. Discourage your child from scratching the area. You should also avoid applying any powders, creams, or lotions to the treated area. Your child’s doctor may also prescribe ointments or cream to speed healing and reduce irritation.

Hair Loss
If your child received radiation therapy to the head and neck, hair thinning or hair loss (also called alopecia) may result shortly after treatment begins. It’s important to remember, though, that radiation anywhere else but the head and neck will not cause the hair on the head to fall out. Losing hair can be scary for kids, especially if they’re at an age where it’s hard to be different. Getting a shorter haircut may make it less traumatic for your child once his or her hair starts falling out. Your child may also feel more comfortable wearing hats, bandannas, baseball caps, scarves, or wigs until the hair grows back - which may happen within 3 months after treatment ends. Although hair loss is usually temporary, it can be permanent.

Sore Mouth and Tooth Decay
The tissues of the mouth may be sore and sensitive and there may be an increased risk of tooth decay if your child received radiation therapy to the head and neck. These side effects usually occur during the second or third week after beginning therapy and disappear within a month or so after treatment ends. Your child’s doctor may prescribe a mouth rinse to reduce pain and irritation. Be sure to take your child for regular dental checkups and follow the dentist’s advice during radiation therapy.

Gastrointestinal Problems (including loss of appetite, diarrhea, nausea, and vomiting)
In the hours following treatment, your child may experience gastrointestinal upset if he or she received radiation treatment to the pelvis or abdomen. Some children who receive radiation therapy to the head and neck may feel nauseated and vomit.

Even if your child doesn’t feel like eating, it’s still important to focus on good nutrition. Offer foods high in nutrients and talk to your child’s doctor about medicines or dietary changes that may alleviate your child’s upset stomach and prevent weight loss. Several small meals may be easier for your child to consume than fewer larger ones, and bland foods, such as crackers, broth, and rice, may be easier to digest.

Blood Changes
Low levels of platelets and white blood cells (the blood cells that prevent bleeding and help the body fight infection) may also result from radiation therapy. The red blood cell count may be lowered as well. Your child’s doctor will monitor your child’s blood counts regularly and prescribe medication or transfusions if necessary.

Some children who have radiation therapy in the head and neck region also experience long-term or chronic side effects that can occur months to years after the radiation therapy. Although long-term effects can be temporary, they’re usually permanent. Depending on where the radiation was received, the age of the child, and the dose given, long-term effects can include problems with bone growth, fertility, skin changes, and new tumor development.

Your child’s doctor can offer advice and may prescribe medications for making your child more comfortable during radiation treatment. Make sure you avoid giving your child any medications, including herbal medicines or over-the-counter drugs, without your child’s doctor’s OK.

Caring for Your Child
Although the side effects of radiation therapy can be unpleasant, the radiation therapy itself is painless and causes no discomfort. To alleviate your child’s fears before beginning treatment, ask your child’s doctor if a tour of the radiation department can be arranged. Meeting the radiation technologists and viewing the radiation equipment may help your child feel more comfortable during treatment appointments.

When your child asks questions about cancer or treatment, be honest. Discuss your child’s disease in age-appropriate terms, and encourage your child to share his or her feelings. And remember that you and your child aren’t alone: Doctors, nurses, psychiatrists, psychologists, social workers, and other members of the treatment team are there to reassure you and your child before, during, and after radiation therapy.

Once your child has completed radiation treatment, it’s still important for your child’s doctor to monitor your child’s health and progress in follow-up appointments. During these checkups, the doctor will want to know how your child is feeling, whether he or she is experiencing any continuing side effects, and whether there are any signs of the cancer recurring.

Coping with childhood cancer can be a frightening and worrisome time for kids and parents alike, but the good news is that many children treated with radiation therapy go on to live healthy, full lives. Don’t hesitate to approach your child’s doctor with your questions and concerns. The more you know about how radiation therapy will affect and help your child, the more prepared you’ll be during your child’s recovery.

Reviewed by: Donna Patton, MD
Date reviewed: March 2004