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Nascent Drama

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Today, 01:10 AM

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Radiation Side Effects
The radiation side effects experienced by the normal body tissues during and after radiotherapy can be loosely divided into Acute and Late effects.

Acute radiation side effects constitute the acute reaction occurring during radiation and in the immediate weeks and months following treatment.
 
Acute Radiation Side Effects

Radiation treatment is painless and without sensation, with the exception of some mechanical sounds produced by the treatment machine associated with the start and finish of the treatment. Many patients receiving radiation therapy will experience very little reaction, but in most the normal tissues will develop some degree of radiation reaction. This varies in amount and type, depending on the part of the body treated and the amount of normal tissue included in the radiation treatment.

The degree to which individuals experience reaction varies considerably, but this section will deal with some general principles of radiation reaction. Where large areas of a patient are treated, such as the whole abdomen or chest, the reaction experienced will be mainly of a general nature. When small areas are treated the reaction will be confined to that area of the body that is radiated and to the individual tissues included in the treatment volume. Any general reaction will be much less or absent altogether.
 
General Side Effect Symptoms

Radiation Nausea. The degree to which patients experience nausea following treatment is very variable. Some people will experience hardly any at all, whereas others will be troubled by nausea or vomiting during the early part of the treatment and, in some instances, throughout the treatment. If it occurs, nausea is likely to be worst from two to several hours after treatment. The patient should be encouraged to maintain fluid intake.

The following dietary steps may prove helpful:

1.Salty foods or ice cold drinks help control nausea
2.Avoid greasy foods, strong-smelling or overly sweet foods
3.Small, frequent meals eaten slowly

If insufficient, anti-nausea medication may be prescribed. In most patients nausea improves as the treatment progresses.
 
Hair Loss. Hair loss will only occur within the radiation field. Scalp hair will only be affected if the head receives radiation.
 
Fatigue / Malaise. Some degree of tiredness and lack of energy is often experienced. This will not prevent most people from working or undertaking normal duties but, in some, reduction in activities during treatment and immediately afterwards will be advised.
 
Low Blood Count. Reduction in certain elements of the blood is often seen following radiation therapy. This results from radiation exposure of bone marrow, and to a lesser extent, direct damage to lymphocytes in the blood stream and lymph nodes.

The white cell count will be reduced, particularly the lymphocyte count, and the number of platelets will be reduced. These drops are seldom enough to cause clinical problems, but if they are, an interruption in treatment for a few days is usually sufficient to allow recovery. Reduction in red cells does not occur to any degree in radiation treatment, but may occur from blood loss due to bleeding.

Changes in the peripheral blood count are much more marked in patients who have also received chemotherapy.
 
Organ Specific Side Effect Symptoms

Localized reactions will occur in any tissues exposed to radiation treatment. The acute reactions expected for different treatments will be considered later, but in general acute reactions result from radiation of skin, mucous membranes and accessory glands.
 
Skin. Where the skin receives a significant dose of radiation a reaction will develop which progresses through erythema to dry desquamation and moist desquamation. The reaction may only progress part way through these steps and healing occurs through the same steps in reverse. If desquamation has occurred, crusts will form which protect the re-epithelialisation occurring underneath and will only come away and not reform when the skin is healed underneath.

The reaction develops two or three weeks after the initiation of treatment and may take four to six weeks to heal. It is best managed by:

1. Avoiding irritation from clothing, deodorants, perfumes, heat, dust and trauma
2. Best of all, leaving the area open to the air
3. Using non-stick dressings
4. Opinions vary about moisture. If the area is bathed, dry carefully, do not rub or inflame with soaps, and dust with corn starch
5. Steroid creams may help
6. Hair loss may be temporary or permanent, depending on the amount of radiation. Hair loss only occurs in skin exposed to radiation treatment
7. Avoid direct sunlight on the treated area
8. Have patience, the reaction will heal
 
Mucous Membranes. Wherever mucous membranes are included in a radiation field similar reactions will be experienced: Whether in the mouth, pharynx, esophagus, trachea, bowel, bladder or rectum, mucositis may develop.

As with the skin, the mucosa is reddened at first but then may be covered with a plaque-like fibrin similar to crusting of the skin. The mucous membrane remains moist and the surface covered by fibrin until the underlying mucosa is healed, when the fibrinous plaque is lost and the reaction healed.

The symptoms resulting from the inflammation, irritation and dysfunction caused by the mucosal reaction depend on the site of the reaction. There may be discomfort and dysphagia or cough, hoarseness and tracheitis, or dysuria and frequency, or diarrhoea and abdominal cramps. The management varies from site to site, but depends on the same principles as the care of skin reaction.

1. Avoid irritation by keeping food or stools soft and preventing trauma of any kind.
2. Local analgesic mixtures, antibiotics where indicated, and steroids may help.
3. Maintain hydration by encouragement and intravenous fluids if necessary.
4. Low fibre diet for those with bowel reaction.
5. Best of all, have patience, the reaction will heal.
 
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