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Instructions to Patients

HomeKnow CacnerInstructions To Patients
HomeKnow CacnerInstructions To Patients

Radiation Theraphy to the Abdomen

Please follow these simple instructions during the course of the therapy. Please show this to your referring or family doctor for their information and guidance

Diet
  • 1. Drink plenty of fluids (2-2.5 liters) daily - water, coconut water, barley water, electrol powder solution.
  • 2. Coffee and tea can be taken in moderation.
  • 3. Bland, non-oily low residue but well balanced diet advised.
  • 4. Avoid spicy food. Eat small, frequent meals.
  • 5. A high protein or carbohydrate rich diet preferable.
  • 6. Do not take any laxative without consulting doctor.
Skin Care
  • 1. Preserve any marks on skin carefully. Tattoo marks may be made on some patients for positioning.
  • 2. Do not apply hot water or ice packs.
  • 3. Gently sponge with lukewarm water. Dab skin dry gently.
  • 4. Please do not use any oils, lotions or cosmetics in the treatment area (only talcum powder may be used).
  • 5. Avoid adhesive tapes in treatment area. Use transpore or micropore only for dressings.
  • 6. The doctor will prescribe ointments or G.V paint for any skin reactions in the groin.
  • 7. Wear loose, cotton clothings.
Abdominal Complications
  • 1. Diarrhea and cramps may occur after the second week of treatment.
  • 2. Consult your doctor for specific medications for vomiting, diarrhea and/or abdominal cramps.
Urinary Complications
  • 1. Drink over 2-2.5 liters of liquids per day.
  • 2. Consult your doctor for specific medications for burning and frequency of urine.
General
  • 1. Weigh yourself weekly.
  • 2. Pamper yourself with plenty of rest.
  • 3. Blood counts may be checked at intervals.
  • 4. Most side effects will settle down within 10-12 days after completion.
  • 5. Feel free to discuss any problem with our doctor.
Expected Side Effects
  • 1. Loss of appetite, feeling of weakness and tiredness.
  • 2. Nausea, vomiting and dehydration during the last 2-3 weeks.
  • 3. Diarrhea and/or painful defecation after the 2nd week.
  • 4. Burning and/or increased frequency of urine after 3rd week.
  • 5. Skin changes of dryness, redness, peeling may occur after 2-3 weeks.
  • 6. Radiation reactions may be aggravated when given along with Chemotherapy.
  • 7. The side effects will be minimized if you follow the instructions carefully.

Breast Cancer

Breast Cancer is one of the Cancers afflicting a large number of women. The causes of Breast Cancer are not fully known. Simply being a woman and growing older put you at risk. However, there are certain known risk factors which are in your control.

Factors You Can Change
  • 1. Being overweight or gaining excessive weight as an adult.
  • 2. Not getting regular exercise.
  • 3. Not having been pregnant puts you at higher risk.
  • 4. Eating a diet high in fat.
  • 5. Breast feeding offers protection against malignancy.
  • 6. Smoking.
  • 7. Drinking more than one alcoholic drink per day.
  • 8. Having several risk factors for breast cancer only means that your chances of getting the disease are higher than women who have fewer risk factors.
Warning Signs of Breast Cancer

Finding a lump or change in your breast does not necessarily mean you have breast cancer.

Breast Cancer can be prevented by identifying changes in the breast at an early stage. If you find any of the following symptoms in your breast, you should see an oncologist.

  • 1. Hard lumps, thickening in any part of the breast.
  • 2. Unusual swelling, redness or increased warmth of your breast.
  • 3. Lump in same side armpit.
  • 4. Change in the size or shape of your breast.
  • 5. Dimpling or puckering of the skin on your breast.
  • 6. Itchy, sore or scaling area on the nipple.
  • 7. Pulling in of your nipple or other parts of your breast.
  • 8. Nipple discharge.
Detection & Prevention of Breast Cancer

The following can aid you in identifying breast cancer at an early stage.

  • 1. Monthly breast self-examination starting by age 20.
  • 2. Clinical breast examination by a trained medical professional every 3 years starting at age 20 and annually after 40.
  • 3. Annual mammography screening starting at age 40.
  • 4. Women under 40 with either a family history of breast cancer or other concerns about personal risk should consult with a trained medical professional about risk assessment and when to begin mammography.
Self Examination
  • 1. Examine your breasts in a mirror. Has there been any change in size? Has one nipple become turned in? Any sign of discharge? Is there any puckering, dimpling or change in skin texture?
  • 2. Raise hands above your head and examine breasts leading to armpit. Any swelling or skin puckering? Lower and raise your arms while watching your nipples. Do they move the same distance?
  • 3. Lying down, start with left breast using right hand. Use the flat of your hands to feel for any lumps, thick or bumpy area. Press firmly and feel the entire breast and lastly arm pit also. Repeat whole examination in right breast. If you detect anything, consult your doctor immediately.
What is Mammography?

Mammography is a specific type of imaging that uses a low-dose X-ray system for examination of breasts. It plays a crucial part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them. Current guidelines recommend mammography every year for women from the age of 40 years.

On the day of the test
  • 1. Inform your doctor of if you are pregnant any prior surgeries and family or personal history of breast cancer.
  • 2. Do not schedule your mammogram for the week before your menstrual period as your breasts are usually tender during this time. The best time is one week following your menstrual period.
  • 3. Please wear comfortable loose clothing while coming for the test.
  • 4. Please do not bring valuables such as jewelry, credit cards and cell phones.
  • 5. Do not apply deodorant, talcum powder, or lotion under your arms or on your breast on the day of the test as these can appear as calcium spots.
  • 6. Describe any breast symptoms or problems to the technologist performing the test.
  • 7. Please bring any old mammograms, if you have, for the comparative study.
  • 8. Your mammography is performed by a registered technician.
  • 9. The images will be interpreted by a qualified radiologist.
How is the test performed?

A specially qualified radiographer/technologist will position you to image your breast. The breast is first placed on a special platform and compressed with a paddle.

The technologist will go behind a glass shield while making the X-ray exposure, which will send a beam of X-rays through the breast to the film behind the plate, thus exposing the film. You will be asked to change positions slightly between images. The routine views are a top-to-bottom and a side view. The process is repeated for the other breast. The examination process should take about half an hour. When the mammography is completed, you will be asked to wait until the technologist examines the images to determine if more are needed. A sono-mammography might be asked for by the Radiologist on review of the mammography films.

After the test

You will be able to resume your usual activities. Date and time for the collection of the report shall be communicated to you. Your physician will discuss the test results with you.

Are there any risks associated with the test?

You will feel pressure on the breast as it is squeezed by the compressor. Some women with sensitive breasts may experience discomfort. If this is the case, schedule the procedure when your breasts are least tender. The technologist will apply compression in gradations. Be sure to inform the technologist if pain occurs as compression is increased. If discomfort is significant, less compression will be used.

For more information please contact
Radiology Department:
Extension: 4020

Chemotherapy

A Guide for People With Cancer

This guide helps you to understand chemotherapy. Your family and friends may also find it helpful to learn about your treatment. You will find information about:

  • 1. Chemotherapy and how it works.
  • 2. Common side effects and helpful tips to manage them.
  • 3. How to look after yourself during treatment.

Everyone is different and everyone’s cancer treatment and side effects are different. Talk to your healthcare team about your situations. Tell them about any side effects you may have. This booklet is designed to help you work with your healthcare team.

Working with Your HealthCare Team

Teamwork is needed to treat cancer. Before treatment begins, you will meet with your healthcare team to discuss the choices that are available to you. Your healthcare team will consider.

  • 1. The type of cancer you have
  • 2. The state and grade of your cancer (how far it has progressed)
  • 3. Your age
  • 4. Your general health
  • 5. Any other medical problems you might have. Your healthcare team will make recommendations about your care and treatment. Your situation is unique and you will help to make the final decisions that are right for you. The team working with you may include many different professionals.

A Surgeon performs any biopsies (cells or tissues are removed from the body and examined to help with a diagnosis) or surgery that you may need.
A Radiologist reads and interprets X-rays and other imaging tests. They also perform biopsies during the specialized X-ray procedures.
A Pathologist looks at the tissue from the biopsy under a microscope to see if it has cancer cells.

A Medical Oncologist specializes in the treatment of cancer suing different medications, such as chemotherapy drugs.
A Radiation Oncologist treats the cancer with special X-ray therapy (Radiation).
A Surgical Oncologist treats the cancer by removing lumps or tumors from the body.
An Oncology Nurse has received special education and has experience in caring for people with cancer.
An Oncology Pharmacist prepares and dispenses cancer drugs and other medications, and helps teach you about your medications.
An Oncology Social Worker or Psychologist provides support and can help you and your family cope with the disease and its treatment.
A Physiotherapist helps with the physical recovery from your illness. They can help maintain and help improve your overall fitness and health.
A registered Dietician has received special education in nutrition and has additional clinical training. They can offer you counselling about your diet during your cancer treatments. Your family doctor plays an important part in continuing your care, especially after your cancer treatments are over.
You are the most important member of your healthcare team. As a member of the team, you should:

  • 1. Be involved in decisions that affect you.
  • 2. Learn about your cancer and your treatments in a way that feels right for you.
  • 3. Talk to your healthcare team about your worries or concerns.
  • 4. Keep your doctor, clinic and hospital appointments.
  • 5. Write down questions to ask your healthcare team, so that you won’t forget them at your next appointment.
  • 6. Ask your healthcare team how you can contact them between appointments if you have any questions that need answers sooner.
Cancer and Chemotherapy

Cancer is a disease that starts in our cells. Our bodies are made up of millions of cells, grouped together to form tissues or organs such as the lungs, the liver, muscles and bones. Normally our cells obey their orders and we remain healthy. Sometimes a cell’s instructions get mixed up and it behaves abnormally. After a while groups of abnormal cells form lumps or tumors.


What is Chemotherapy?

Chemotherapy is a method of treating cancer by using drugs. Often, a combination of chemotherapy drugs is used. Chemotherapy is one of many different ways to treat cancer. The three most common ways are surgery, radiation therapy and chemotherapy. Surgery removes the cancer from one area of your body to destroy cancer cells. Chemotherapy is different from surgery or radiation therapy because it affects the whole body.


How Chemotherapy works?

Cancer cells grow in an uncontrolled way. Chemotherapy drugs slow or even stop the cancer cells from growing, multiplying or spreading to other parts of your body.


The Goals of Chemotherapy
  • 1. Destroy the cancer
  • 2. Shrink a tumor before other treatments
  • 3. Destroy cancer cells after other treatments
How long does Chemotherapy treatment last?

Each cancer is different so each treatment plan is different. Your healthcare team will estimate how long your chemotherapy schedule will last. You may get chemotherapy treatment every day, every week or every month.


How is Chemotherapy treatment given?

Chemotherapy drugs can be given by mouth (orally) or by injection, depending on type of chemotherapy. Your healthcare team will help you decide on the method that is best for you.


Is Chemotherapy painful?

Chemotherapy treatments should not be painful, but they can cause side effects that are painful.


How will you know if the Chemotherapy treatment is working?

During regular visits with your healthcare team, they will check how you are doing and how well the treatment is working. They will check your progress with physical exams, blood tests, imaging scans and X-rays. These tests will show if the chemotherapy drugs are destroying the cancer cells.


Chemotherapy and other medications

Before your first treatment, let your healthcare team know about any other medications you are taking. These medications might interact with chemotherapy drugs, making them less effective or producing side effects.


Chemotherapy and You - Fever and Infection

Chemotherapy lowers the number of white blood cells (WBCs) your body makes. A fever of 1010 F (38.30C), or chills with or without a fever, can be a serious sign of infection. You must call your oncologist should this occur even if you experience these symptoms at night or on the weekend.


Practical Hints regarding Fever & Infection
  • 1. If you have a fever of 1010 F (38.30 C) with or without chills, call your care provider immediately, if you cannot reach your oncologist, go to an emergency room.
  • 2. Keep a thermometer in your home and know how to take your temperature in the following manner.
  • 3. Do not eat, drink (or smoke) for 10 minutes before taking your temperature.
  • 4. We encourage frequent hand washing with soap and water.
  • 5. Do not eat raw food.
  • 6. Wash hands and cutting boards well after food preparation.
Flu like symptoms

Around the third day following a chemotherapy treatment, some people may experience flu like symptoms such as muscle aches and pains. If you experience these aches, you can take over the counter medications that you regularly use, such as Crocin.


Nausea

Practical Hints for Nausea

Before your chemotherapy appointment, eat a small, light meal. Eat what sounds good to you Plenty of fluids, herbal teas, water, “sports drinks” and diluted juices are recommended more than soda. Avoid smells that are unappealing.


Fatigue

Chemotherapy can make you feel tired.

Practical Hints for Fatigue

Plan your activities such as grocery shopping, for a time when you feel the best. Take naps early in the day so you do not disturb your sleep pattern at night. Consider exercising everyday or several times a week. Good forms of exercise include swimming, walking and yoga.


Hair Loss

Many people feel that hair loss is one of the most difficult aspects of chemotherapy treatment. Not all chemotherapy drugs cause hair loss, so talk to your physician. Most often hair loss begins about 2-3 weeks after starting chemotherapy. You may want to cover your head with a wig, scarf, hat or turban, or you may not want to cover your head at all. Do what makes you feel most comfortable. Your hair will begin to grow back after you stop chemotherapy. It usually takes from 2-3 months to see the change from no hair to some hair.


Appetite and Taste changes

During chemotherapy you may experience taste and appetite changes and a heightened sensitivity to odors. Do not worry if you don’t have an appetite the first few days or a week following chemotherapy. It is not unusual, and as you feel better your appetite will improve.

Practical hints for Taste and Appetite changes

Eat what appeals to you during this time. Eat foods that are warm rather than hot. Avoid places where food is being cooked. Avoid smells that are unappealing. To try drink 8-10 glasses of fluid a day.


Diarrhea or constipation

Some chemotherapy drugs can cause diarrhea. If you have more than three or four watery stools in 24 hours, or blood in your stool, call your care provider.

Practical Hints for constipation

To help prevent constipation try drinking 8-10 glasses of fluid a day. Stay as active as you can, as consistent regular exercise can reduce constipation.

Practical Hints for Diarrhea

To replenish lost fluids, drink 8-10 eight ounce glasses of decaffeinated fluids per day.


Mouse Sores

Another side effect of chemotherapy can be mouth sores and discomfort when swallowing. Mouth sores occur because chemotherapy not only destroys cancer cells, but also rapidly dividing cells.

Practical Hints for Mouth Sores

Brush your teeth a soft toothbrush 3 times daily. Rinse your mouth with a solution of 1 teaspoon baking soda and 1 teaspoon of salt, diluted in a glass of lukewarm water 3-4 times daily.

Radiation Therapy to Head & Neck Tumors

Please follow these simple instructions during the course of the therapy. Please show this to your referring or family doctor for their information and guidance.

Practical Hints regarding Fever & Infection
  • 1. Preserve marks on skin when made. Normally a customisedmould will be made to facilitate treatment positioning.
  • 2. Do not expose to direct sunlight.
  • 3. Gently sponge the area with lukewarm water. Dab dry gently.
  • 4. Use body talcum powder only in treatment area.
  • 5. No medication, oils, deodorants, or cosmetics to be applied in treated area. Avoid scratching or rubbing of the area. Do not apply hot water bottles or ice bags. Using electric shaver is recommended.
  • 6. Do not use adhesive tape for dressing. Only use of transpore or micropore is suggested.
  • 7. Wear loose, cotton clothings.
  • 8. The doctor will prescribe ointments or GV paint if needed, for peeling of skin.
Mouth Care
  • 1. Good dental hygiene to be maintained. Use a soft toothbrush.
  • 2. Carious, loose teeth must be extracted before Radiotherapy.
  • 3. Regular application of Fluoride Gel for 3 months.
  • 4. Do not extract any teeth for 1 – 2 years after therapy.
  • 5. Frequent mouth washes using antiseptic rinses.
  • 6. Salt and Soda-Bicarb gargles (1 pinch each in 1/2 glass water) every 2 hrs are helpful.
  • 7. Avoid spicy, hot, rough, fried or citric foods.
  • 8. Liquids to wash down food during meals.
  • 9. Blenderized or soft diet with plenty of gravy.
  • 10. Eat small, frequent meals.
  • 11. Avoid alcohol, smoking and pan/ tobacco chewing.
  • 12. Sips of water every few minutes to moisten mouth throughout the day.
  • 13. Check with doctor for further medications.
  • 14. If using dentures, keep then clean by soaking / brushing everyday.
  • 15. Can chew sugar-free gum to keep mouth moist.
  • 16. Exercise your jaw muscles.
Expected Side Effects
  • 1. Skin changes of dryness, redness and peeling may occur after 2-3 weeks.
  • 2. Dryness of mouth with sticky saliva.
  • 3. Bad taste and smell in mouth.
  • 4. Loss of taste.
  • 5. Soreness in oral cavity after 2nd week.
  • 6. Difficulty in eating, drinking and swallowing after 3rd week.
  • 7. Temporary loss of hair in treated area after 2-3 weeks.
  • 8. Radiation reactions aggravated when given along with Chemotherapy.
  • 9. The side effects will be minimized if you follow the instructions carefully.
Dos and Don’ts during Radiotherapy
  • 1. Do not get exposed to Sunlight for a long time.
  • 2. Do not rub or scratch on skin marks site.
  • 3. Do not apply any ointment, cream, soap, oil on radiation site.
  • 4. Do not wash the radiation site too often.
  • 5. Do not apply any adhesive tape on that area.
  • 6. Do not shave on the radiation site, can use trimmer.
  • 7. Do not move on the treatment table, while taking treatment.
  • 8. Avoid spicy fried food.
  • 9. Avoid very hot or very cold foods or drinks.
  • 10. On account of any new complaints kindly contact the Doctor.

Radiation Therapy to Thorax

(Chest Wall, Lung, Eesophagus, Breast) Please follow these simple instructions during the course of the therapy. Please show this to your referring or family doctor for their information and guidance.

Precautions Regarding Treatment Area
  • 1. Preserve any marks on skin carefully. In some cases, marks will be tattooed for positioning.
  • 2. Bath with lukewarm water. Dab skin dry very gently.
  • 3. Do not rub the skin. Keep dry with body talcum powder.
  • 4. Do not expose to direct sunlight, hot water bottles or ice bags.
  • 5. Do not apply any lotions, oils or deodorants during treatment.
  • 6. Avoid adhesive tapes for dressings.
  • 7. Use transpore or micropore only.
  • 8. Wear loose, cotton clothes.
  • 9. The doctor will prescribe any ointments or GV paint when indicated.
  • 10. After mastectomy, arm exercises are recommended as soon as possible.
Care
  • 1. Plenty of rest.
  • 2. A high protein and carbohydrate diet to be maintained.
  • 3. Bland, non oily, soft diet when advised.
  • 4. Plenty of liquids (2-2.5 liters daily).
  • 5. Avoid alcohol, smoking and pan/ tobacco chewing.
  • 6. Blood counts to be checked regularly.
  • 7. Weigh yourself weekly.
  • 8. Most side effects will settle down within 10 - 12 days of completion of radiation.
  • 9. Consult your doctor for any specific problems.
Expected Side Effects
  • 1. Cough and irritation in the throat.
  • 2. Difficulty and pain on swallowing after the second week.
  • 3. Change in voice in some cases.
  • 4. Nausea and vomiting in some cases.
  • 5. Skin changes of dryness, redness, itching and peeling may occur after 2-3 weeks.
  • 6. Weakness and tiredness during the last 2 weeks of treatment.
  • 7. Aggravated side effects when given along with Chemotherapy.
  • 8. The side effects will be minimized if you follow the instructions carefully.
  • 9. These side effects are temporary and will resolve gradually after completion of treatment.
  • 10. Don’t hesitate to ask your doctor about any complaints other than those mentioned above.
Expected Side Effects
  • 1. Skin changes of dryness, redness and peeling may occur after 2-3 weeks.
  • 2. Dryness of mouth with sticky saliva.
  • 3. Bad taste and smell in mouth.
  • 4. Loss of taste.
  • 5. Soreness in oral cavity after 2nd week.
  • 6. Difficulty in eating, drinking and swallowing after 3rd week.
  • 7. Temporary loss of hair in treated area after 2-3 weeks.
  • 8. Radiation reactions aggravated when given along with Chemotherapy.
  • 9. The side effects will be minimized if you follow the instructions carefully.

Throat Cancer

‘Throat Cancer’ as is commonly referred to comprises cancer of the Larynx (voice box) and cancer of the Hypopharynx (upper part of the swallowing tube). This is a common cancer in our country and constitutes about 12% of all cancers. Around 80,000 throat cancers are newlydiagnosed every year in our country.

Causes

Majority of these cancers are caused by the use of tobacco in various forms. While smoking usually results in an increased incidence of Larynx cancer, chewing tobacco causes an increase in the incidence of Hypopharyngeal cancers. In those who do not chew or smoke tobacco, the cause is believed to be genetic.

Warning Signals

The usual symptoms of these cancers are:

  • 1. Persisting sore throat.
  • 2. Hoarseness of voice.
  • 3. Difficulty and pain in swallowing.
  • 4. Enlarged glands in the neck.If any of these symptoms last for more than 3 weeks, it is necessary to have cancer ruled out especially in those habituated to tobacco.

In later stages, there may be difficult or noisy breathing and total obstruction resulting in inability to even swallow liquids and choking.

Treatment

These cancers are highly curable in the early stages. Even in the later stages, cancer of the Larynx, specially, still has a high percentage of cure with proper treatment. Treatment consists of Surgery, Radiation therapy or a combination of both. Sometimes, chemotherapy is also added where the cancer is more advanced. In the early stages, surgery only involves removal of a part of the voice box and voice can be preserved. However, in more advanced stages, the entire larynx has to be removed in a procedure called Total Laryngectomy. Following total Laryngectomy, normal speech is lost. However, with developments which have taken place recently it is now possible for total Laryngectomy patients to speak by the insertion of a voice prosthesis at the time of surgery or later. All patients who undergo Laryngectomy at the Apollo Cancer Institute are now encouraged to have this prosthesis inserted and get back their speech. Radiation therapy is an alternative to surgery. It is primarily used when the cancer in the throat is at an early stage. It may also be used in more advanced cases where the patient is not willing for total laryngectomy or is unfit for the surgery. New trials are in progress, where in radiation therapy is combined with chemotherapy to give better results in patients with advanced disease. Surgery is the only treatment in patients who have failed radiation therapy.

Laryngectomee Society

A laryngectomee is a person who has undergone Laryngectomy. In order to get all these people together towards a common goal, a Laryngectomee Society has been started at the Apollo Cancer Institute, where laryngectomees and their relatives meet once in a month and to interact socially. Laryngectomees try out their voices, discuss, try to find solutions to each other’s problems, give and receive encouragement. The society meets on the 2nd Saturday of every month at 11 a.m., at Apollo Cancer Institute. A Dietician, Physiotherapist & Medical Social Worker also participatein order to facilitate the rehab of these members.

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