Patients with gastrointestinal cancers are cared for at our facility by a multidisciplinary team consisting of surgeons, radiation oncologists, medical oncologists and gastroenterologists. In our radiation oncology department, we have expertise in the management of esophageal, gastric, pancreatic, hepatobiliary, rectal, and anal cancers using both 3-dimensional conformal and intensity-modulated radiation therapy (IMRT). Our department is equipped with CT-based image-guided radiation therapy (IGRT) equipment, which we use routinely to ensure that treatments are delivered with precision and accuracy. Our team also includes experienced nurses, dietitians, and social workers who are available for patients’ daily needs.
Radiation treatments for gastrointestinal malignancies are often given in addition to surgery and/or chemotherapy. Specifically, a chemotherapy drug called 5-fluorouracil (5-FU) is often given with radiation to act as a radiation sensitizer against malignant cells. The radiation series typically lasts 5 to 7 weeks, once per day five days per week. Occasionally, we treat according to a “split course” schedule which may add to the total length of time under treatment by introducing treatment breaks at planned intervals.
Many patients experience fatigue starting during the second or third week, which can progress as the treatment progresses. This typically subsides gradually over 2 to 6 weeks following the radiation treatment. The fatigue is not normally debilitating and in itself should not effect your daily activities or ability to drive. However, you may wish to go to bed earlier or take a nap during the afternoon. Fatigue and weakness are worse in patients who lose weight. Accordingly, our dieticians strongly encourage you to supplement your diet with high calorie foods or commercially available nutritional supplements (for example, Ensure Plus, Boost), if necessary to maintain your weight.
Your blood counts may require monitoring periodically during treatment, especially if you also receive chemotherapy.
If treatment is directed toward the upper abdomen, the major short-term side effects typically include nausea with or without vomiting, loss of appetite, upper abdominal pain reminiscent of ulcers and sometimes, crampy diarrhea. A variety of medicines, both prescription and over-the-counter, are available to treat all of these effects and will be employed as needed.
When the pelvic area is treated, such as in patients with rectal cancer, there tends to be less difficulty with nausea and vomiting, but a greater problem with diarrhea and intestinal cramping. These symptoms are typically improved through avoidance of fiber in the diet and appropriate medications such as Imodium. Our dieticians will consult with you regularly during your treatment regarding any dietary alterations.
When pelvic radiation is given, the bladder and urethra may also become irritated such that urination becomes more frequent, especially at night, causing you to arise multiple times, occasionally with mild burning discomfort as well. Again, appropriate medications may be given to decrease this problem.
The skin within the treated area may become red with temporary itching and discomfort. This is particularly problematic in patients treated for pelvic malignancies, such as rectal cancer in which case the reaction in the region of the buttocks and anus is particularly annoying. There are a variety of topical measures used to alleviate this condition.