Our Approach to Radiation Therapy
A cancer diagnosis can be a challenge to absorb. It’s not easy to manage treatment along with work or school, relationships, and other life priorities. At the Stanford Cancer Center, we’re here to help.
During your cancer treatment, your doctors may recommend approaches to care that include surgery, drug therapy, or radiation therapy. This overview is to explain more about the types of radiation therapy and their possible roles in your care.
Radiation therapy is a form of high energy x-ray’s which can destroy or prevent the spread of cancer. The goal is to target cancer, while minimizing exposure to surrounding healthy cells.
Regarding your treatment plan, please keep in mind that:
- It may involve one or more of the three main types of treatment: radiation therapy, surgery, and drug therapy (medications like chemotherapy that travel through the bloodstream to attack cancer anywhere in the body.
- Your doctors may prescribe a treatment plan that combines treatments.
The combination of treatment types may need to take place in a specific order to best treat your specific condition.
Your health care team will work with you to develop a treatment plan. If that includes radiation therapy, the team will talk to you about your treatment goals.
To learn more about how to prepare and what to expect before, during and after your radiation therapy experience at Stanford Health Care, explore our online health class, Having Radiation Therapy at Stanford.
WHAT TO KNOW WHEN CONSIDERING RADIATION THERAPY
GETTING STARTED IN YOUR CARE
GETTING YOUR DIAGNOSIS
PLANNING YOUR TREATMENT
UNDERGOING TREATMENT & FOLLOW UP
GETTING STARTED IN YOUR CARE
GETTING YOUR DIAGNOSIS
PLANNING YOUR TREATMENT
Information about your condition, diagnosis, and treatment planning.
Learn more about what to expect of treatment
Radiation Therapy: Patient Care Resources »
Learning that you may have cancer plunges you into uncertainty. The more you understand about your condition, the greater your sense of control you will feel. This overview explains diagnosis and treatment planning, to help you understand what to expect as you go through the early steps of your care.
Learn more about how radiation therapy works and the role in may play in your treatment plan.
Learn more about approaches to treating tumors of the brain and spine with radiation therapy.
Learn more about the role of radiation therapy in the treatment of breast cancers.
Learn more about the role of radiation therapy in the treatment of digestive system cancers.
Learn more about the role of radiation therapy in the treatment of gynecologic cancers.
Learn more about the role of radiation therapy in the treatment of head and neck cancers.
Learn more about the role of radiation therapy in the treatment of lung cancers.
Learn more about the role of radiation therapy in the treatment of lymphomas.
Learn more about the role of radiation therapy in the treatment of prostate cancers.
Before
During
After
Meet with your radiation oncologist
The first appointment with your cancer doctor is an opportunity for you to ask any questions. In your first visit, you will:
- Discuss treatment options, including whether or not radiation treatment is recommended for you.
- Discuss the exact type, number of treatments, and potential side effects of radiation treatment, if recommended.
- Bring any paperwork and imaging done outside Stanford for your doctor to review.
- Be offered your next appointment for a simulation scan in preparation for your radiation treatment (a scan, in treatment position), if appropriate.
Your first visit is also an important opportunity to tell the doctor and care team about your past medical history and all of the medicines you take – even occasionally. Some prescriptions, vitamins, supplements, and herbal remedies can affect how your body responds to radiation therapy, so it is important to tell your doctor about all of them.
We can help you get started with a checklist of what to expect and what to prepare.
Come in for the simulation
A simulation scan is done to get images of the cancer site, with you placed in the exact position you will be during all of your radiation treatments. These images are used to design a radiation plan that is customized to your specific body and anatomy. This appointment usually takes about 1-3 hours, depending on the types of scans that are recommended.
Developing a treatment plan
After your simulation, your team works together to plan your series of treatments. During the planning:
1. The radiation oncologist defines on the simulation scan where the exact target area in your body will be as well as the surrounding normal organs that need to be avoided
2. Once the targets and normal organs are defined and the prescription dose is determined, the dosimetrist designs your radiation plan.
3. The dosimetrist precisely calculates the dose to the target area while avoiding surrounding healthy tissue.
4. Your radiation oncology approves the treatment plan after ensuring its safety and efficacy and submits it to our physics team.
5. Our physics team puts your treatment plan through an extensive quality assurance process:
- We double-check every patient’s treatment plan for the best, most accurate delivery.
- We perform daily, monthly, and annual checks of all systems (computers, simulators, delivery machines).
- We use third-party monitoring and credentialing to ensure the highest quality of care.
We use the information we gathered during the simulation appointment to carry out your treatment plan. During your series of treatments, you will see the care team at each visit and meet with your doctor each week to discuss the treatment progress and side effects.
Your first treatment
At your first visit following the simulation scan, you will have your first treatment. We will also schedule your remaining appointments.
Appointment date:
- You will come back for your first treatment about 1 to 2 weeks after your simulation.
- This appointment is usually in the afternoon to allow time for our physicist to double-check your plan.
- The remaining sessions can be anytime between 7:30 a.m. and 5 p.m., Monday through Friday. Your therapist will work with you to find a time that fits your schedule.
Check in:
1. Check in at the same place as you did for your simulation.
2. Verify your name and date of birth.
3. After check-in, please proceed to the patient-only waiting area.
4. Your radiation therapist will take you to the treatment room.
Treatment steps
Here’s what you can expect during your radiation treatment session.
- Reminders:
- It is important to try to relax and hold still during treatment.
- You can listen to music during your session.
- Positioning:
- Your radiation therapists position you in your immobilization device.
- They use your tattoos or skin markings to align you properly in the machine.
- Imaging:
- Before we start your treatment, your team verifies the target treatment area.
- Your team takes a few X-rays and compares them to the treatment plan.
- Treatment:
- During treatment, a machine will move around you to deliver radiation from different angles.
- Nothing will touch you, and you will not feel anything.
- Audio and visual monitoring:
- During treatment, your radiation therapists can see, hear, and speak with you from outside the treatment room. Talk to them if you have a question.
Your remaining treatments
During your first appointment, your team will give you the schedule for the rest of your treatments:
- The radiation therapists will do the same procedures as they did during your first treatment.
- The exact length of time for each treatment may vary from day to day.
- Your radiation oncologist may order additional imaging to be done during some of your appointments.
Weekly visits with your doctor
Your radiation oncologist will meet with you once a week during your series of radiation treatment. This visit will take place at one of your scheduled treatment sessions and is called an on-treatment visit (OTV).
1. On the day of your OTV, your radiation therapist will take you to the nursing area after your radiation treatment.
2. A nurse will take your vital signs and weight.
3. You will meet with a nurse and your radiation oncologist to review your radiation treatment. We will help you manage any side effects you may have. If you have any problems or symptoms on another treatment day, you can ask the therapist to call the nurse or doctor to see you.
4. You may need labs done once or twice a week. If so, the nursing staff will remind you to have your lab work done a day before your OTV day.
Your final treatment
After your last radiation treatment, you will meet with a nurse to review your after-visit summary:
1. Speak with your nurse about how to care for yourself after your radiation treatment.
2. Schedule a follow-up appointment with your radiation oncologist
3. Make note of our contact information in case you have questions or need to change your follow-up appointment.
4. If appropriate, you will need to meet with your other cancer doctors such as the surgeon and the medical oncologist to determine if any further treatments like surgery and chemotherapy are needed
When your radiation therapy is complete, you will meet with your radiation oncologist for follow-up. Your next steps after that may include:
- Meeting with other care teams for additional treatment, if needed
- Meeting with the cancer survivorship team for supportive care
- Watching for side effects that can develop after treatment
Follow-up appointment
1. If appropriate, you will meet with your doctor 1-3 months after you complete your radiation treatment course.
2. Your radiation oncologist may ask you to have another scan (CT, PET, or MRI) before the follow-up appointment.
3. Your doctor will ask you how you are doing, assess your progress, and offer additional care and guidance.
Cancer survivorship and palliative care
Stanford’s cancer survivorship program provides supportive services to help you and your loved ones. Our services address the physical, emotional, psychosocial, spiritual, and financial challenges of cancer and its treatment. We offer classes, health care, and counseling for cancer survivors.
Our cancer survivorship team works with you to develop a plan for transitioning from active treatment to surveillance and ongoing care. We encourage you to contact our survivorship team early in your treatment process. See the “Survivorship” section on page XX for more information.
Our palliative care specialists work closely with your care team to maintain your quality of life and achieve your personal goals after cancer treatment. Some of our palliative care services include:
- Managing your symptoms
- Helping you define your treatment goals
- Helping you with advance care planning
- Providing social workers for emotional and spiritual support
Find out more about our palliative care and other supportive services for people with cancer. PathWell »
Side effects of radiation therapy and ways to manage them
If you experience side effects from your radiation therapy, please tell your care team. Sometimes, the side effects go away when your treatment is finished. If not, we can provide prescription medications or other suggestions to help you manage side effects.
Meet with your radiation oncologist
The first appointment with your cancer doctor is an opportunity for you to ask any questions. In your first visit, you will:
- Discuss treatment options, including whether or not radiation treatment is recommended for you.
- Discuss the exact type, number of treatments, and potential side effects of radiation treatment, if recommended.
- Bring any paperwork and imaging done outside Stanford for your doctor to review.
- Be offered your next appointment for a simulation scan in preparation for your radiation treatment (a scan, in treatment position), if appropriate.
Your first visit is also an important opportunity to tell the doctor and care team about your past medical history and all of the medicines you take – even occasionally. Some prescriptions, vitamins, supplements, and herbal remedies can affect how your body responds to radiation therapy, so it is important to tell your doctor about all of them.
We can help you get started with a checklist of what to expect and what to prepare.
Come in for the simulation
A simulation scan is done to get images of the cancer site, with you placed in the exact position you will be during all of your radiation treatments. These images are used to design a radiation plan that is customized to your specific body and anatomy. This appointment usually takes about 1-3 hours, depending on the types of scans that are recommended.
Developing a treatment plan
After your simulation, your team works together to plan your series of treatments. During the planning:
1. The radiation oncologist defines on the simulation scan where the exact target area in your body will be as well as the surrounding normal organs that need to be avoided
2. Once the targets and normal organs are defined and the prescription dose is determined, the dosimetrist designs your radiation plan.
3. The dosimetrist precisely calculates the dose to the target area while avoiding surrounding healthy tissue.
4. Your radiation oncology approves the treatment plan after ensuring its safety and efficacy and submits it to our physics team.
5. Our physics team puts your treatment plan through an extensive quality assurance process:
- We double-check every patient’s treatment plan for the best, most accurate delivery.
- We perform daily, monthly, and annual checks of all systems (computers, simulators, delivery machines).
- We use third-party monitoring and credentialing to ensure the highest quality of care.
close Before
We use the information we gathered during the simulation appointment to carry out your treatment plan. During your series of treatments, you will see the care team at each visit and meet with your doctor each week to discuss the treatment progress and side effects.
Your first treatment
At your first visit following the simulation scan, you will have your first treatment. We will also schedule your remaining appointments.
Appointment date:
- You will come back for your first treatment about 1 to 2 weeks after your simulation.
- This appointment is usually in the afternoon to allow time for our physicist to double-check your plan.
- The remaining sessions can be anytime between 7:30 a.m. and 5 p.m., Monday through Friday. Your therapist will work with you to find a time that fits your schedule.
Check in:
1. Check in at the same place as you did for your simulation.
2. Verify your name and date of birth.
3. After check-in, please proceed to the patient-only waiting area.
4. Your radiation therapist will take you to the treatment room.
Treatment steps
Here’s what you can expect during your radiation treatment session.
- Reminders:
- It is important to try to relax and hold still during treatment.
- You can listen to music during your session.
- Positioning:
- Your radiation therapists position you in your immobilization device.
- They use your tattoos or skin markings to align you properly in the machine.
- Imaging:
- Before we start your treatment, your team verifies the target treatment area.
- Your team takes a few X-rays and compares them to the treatment plan.
- Treatment:
- During treatment, a machine will move around you to deliver radiation from different angles.
- Nothing will touch you, and you will not feel anything.
- Audio and visual monitoring:
- During treatment, your radiation therapists can see, hear, and speak with you from outside the treatment room. Talk to them if you have a question.
Your remaining treatments
During your first appointment, your team will give you the schedule for the rest of your treatments:
- The radiation therapists will do the same procedures as they did during your first treatment.
- The exact length of time for each treatment may vary from day to day.
- Your radiation oncologist may order additional imaging to be done during some of your appointments.
Weekly visits with your doctor
Your radiation oncologist will meet with you once a week during your series of radiation treatment. This visit will take place at one of your scheduled treatment sessions and is called an on-treatment visit (OTV).
1. On the day of your OTV, your radiation therapist will take you to the nursing area after your radiation treatment.
2. A nurse will take your vital signs and weight.
3. You will meet with a nurse and your radiation oncologist to review your radiation treatment. We will help you manage any side effects you may have. If you have any problems or symptoms on another treatment day, you can ask the therapist to call the nurse or doctor to see you.
4. You may need labs done once or twice a week. If so, the nursing staff will remind you to have your lab work done a day before your OTV day.
Your final treatment
After your last radiation treatment, you will meet with a nurse to review your after-visit summary:
1. Speak with your nurse about how to care for yourself after your radiation treatment.
2. Schedule a follow-up appointment with your radiation oncologist
3. Make note of our contact information in case you have questions or need to change your follow-up appointment.
4. If appropriate, you will need to meet with your other cancer doctors such as the surgeon and the medical oncologist to determine if any further treatments like surgery and chemotherapy are needed
close During
When your radiation therapy is complete, you will meet with your radiation oncologist for follow-up. Your next steps after that may include:
- Meeting with other care teams for additional treatment, if needed
- Meeting with the cancer survivorship team for supportive care
- Watching for side effects that can develop after treatment
Follow-up appointment
1. If appropriate, you will meet with your doctor 1-3 months after you complete your radiation treatment course.
2. Your radiation oncologist may ask you to have another scan (CT, PET, or MRI) before the follow-up appointment.
3. Your doctor will ask you how you are doing, assess your progress, and offer additional care and guidance.
Cancer survivorship and palliative care
Stanford’s cancer survivorship program provides supportive services to help you and your loved ones. Our services address the physical, emotional, psychosocial, spiritual, and financial challenges of cancer and its treatment. We offer classes, health care, and counseling for cancer survivors.
Our cancer survivorship team works with you to develop a plan for transitioning from active treatment to surveillance and ongoing care. We encourage you to contact our survivorship team early in your treatment process. See the “Survivorship” section on page XX for more information.
Our palliative care specialists work closely with your care team to maintain your quality of life and achieve your personal goals after cancer treatment. Some of our palliative care services include:
- Managing your symptoms
- Helping you define your treatment goals
- Helping you with advance care planning
- Providing social workers for emotional and spiritual support
Find out more about our palliative care and other supportive services for people with cancer. PathWell »
Side effects of radiation therapy and ways to manage them
If you experience side effects from your radiation therapy, please tell your care team. Sometimes, the side effects go away when your treatment is finished. If not, we can provide prescription medications or other suggestions to help you manage side effects.
close After
Radiation therapy uses high-energy radiation such as X-rays to destroy cancer cells. Our radiation oncologists (the doctors who specialize in treating cancer with radiation therapy) use the most advanced equipment and techniques. They target radiation beams to tumors, providing powerful treatment while avoiding damage to healthy tissue nearby.
Radiation therapy is considered local treatment because it focuses on the tumor or cancerous area, not on cancer in other parts of the body. The treatment goals of radiation therapy are to:
- Kill cancer cells and prevent them from spreading
- Destroy any cancer cells that may remain after other treatment. Radiation therapy given after surgery or another primary treatment is called adjuvant therapy.
- Lower the risk of cancer coming back (recurring) after treatment, either at the original tumor site (or nearby) or in other parts of the body
- Shrink or slow the growth of cancerous tumors that are inoperable (cannot be removed with surgery)
At the Stanford Cancer Center, we use two main types of radiation therapy:
External radiation
Our radiation oncologists deliver this type of radiation to the cancer using machines outside the body. The radiation machine moves around your body without touching you.
External radiation therapy does not cause pain, so you won’t feel anything during your treatments.
This treatment, also called external beam radiation therapy (EBRT), does not make you radioactive. You can safely be around other people, including children.
External beam radiation is the most common approach to radiation treatment. It is produced by machines called linear accelerators. Some machines may have brand names, for example TrueBeam and CyberKnife. These machines move around the outside of your body, but they never touch you. The treatment is non-invasive.
Radiation therapy can be delivered in different ways:
- 3D (3-dimensional) conformal radiation therapy (3D-CRT)
With this method, 3D images help the doctor better target the tumor. The images are created using a special machine — a computed tomography (CT) or magnetic resonance imaging (MRI) machine. The radiation beams can be aimed from many different angles to match the exact shape of the cancer. - Intensity-modulated radiation therapy (IMRT)This is a more advanced method that allows the dose to be adjusted (“modulated”) around irregularly shaped targets, which allows for better avoidance of nearby normal cells, and thus less potential side effects.
- Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR)
This method refers to radiation given in 5 or fewer treatments. Though these dose of radiation given is similar to standard radiation, when given in just a few treatments, the effectiveness is much greater, and this treatment is considered much more powerful in killing cancer cells. SBRT/SABR is a specialized treatment technique that is used in specific situations.
Internal radiation (Brachytherapy)
This type of radiation therapy is offered only for certain gynecological and prostate cancers.
When giving internal radiation, called brachytherapy, your doctor positions small catheters or applicators in the treatment area to deliver radiation to where the cancer is. The applications are placed and removed with each treatment. You will receive sedation or anesthesia during the procedure, so the entire experience takes most of a full day. You will not be radioactive and can safely be around others when you return home. Most of the time, treatments can be done as an outpatient (no hospital stay).
The advantage of brachytherapy is that it can deliver higher doses of radiation to certain cancers, while limiting radiation exposure to normal tissue.
Many people need both radiation therapy and surgery or drug therapy (like chemotherapy) during cancer treatment. The factors that influence our recommendation include:
- Type and stage of cancer, often determined by imaging and/or pathology from biopsy or surgery
- Presence of genetic mutations
- Your age, overall health, and personal preferences
Your doctor will discuss the options appropriate for your care, based on your specific case. In general, we recommend radiation therapy in these situations:
As the primary treatment, either alone or with drug therapy (such as chemotherapy, where surgery is either not an option or not the best option.
As additional (adjuvant) therapy after surgery, to kill any cancer cells that may remain after surgery. In this situation, radiation therapy can help lower the chance of cancer returning to that area.
As additional therapy before surgery (neoadjuvant), to help shrink the tumor and make surgical removal easier and reduce the risk of the cancer returning in that area in the future.
- For cancer that has spread (metastasized) to other parts of the body, such as the bones, brain, or lungs. In these situations, we use radiation therapy to treat the cancer wherever it develops in the body to help relieve symptoms that these tumors may cause.
At the Stanford Cancer Center, we offer health care from multiple medical specialists who come together for your individual treatment. That means your doctors will help to coordinate your care as you move from one phase to another – including radiation therapy and possibly surgery and drug therapy as well.
You will have a care team for each type of treatment you have. Learn more about your care team for radiation therapy in the description below:
Your Doctor
Radiation Oncologist
This is a cancer specialist who provides your radiation therapy for cancer. Also called a radiation cancer doctor, he or she has additional specialty training in the use of radiation therapy (i.e. high-energy X-rays) for the treatment of cancers.
In addition to your primary radiation oncologist, the attending physician, there may also be other doctors-in-training called fellows or residents who will also be part of your care team as well as medical students. Stanford is dedicated to teaching and training the next generation of doctors.
View All {0} Radiation Oncologists »
Extended Care Team
This team member is trained in radiation treatment planning. He or she works with your radiation cancer doctor to design a radiation treatment plan that best targets the cancer while avoiding nearby healthy tissues.
This team member reviews the calculations to help confirm the treatment plan and dose. He or she also ensures that the machines which deliver radiation treatment are working properly and that the treatment plan is safe to deliver.
This team member operates the machine, called a linear accelerator or linac, which is used to deliver radiation therapy. The machine directs high-energy X-rays at specific cancer cells in the body, shrinking or removing them.
This health care provider is certified in cancer care and works with your radiation cancer doctor to help with treatment. This provider may recommend medicine or lifestyle changes. They can be a nurse practitioner (NP), physician’s assistant (PA), or clinical nurse specialist (CNS).
Nurse coordinators are specialized registered nurses who provide one-on-one support to guide you through your cancer journey. Nurse coordinators are your contact to help manage your care, from your first appointment through follow-up visits. They assess your needs, answer your questions, make referrals, coordinate appointments, and offer education.
Support Services
Support Services
Depending on your treatment, additional health professionals may be on your care team. You may meet or hear about these team members during your visits.
- Genetic counselor
These health professionals have specialized experience in cancer genetics, the study of genes and gene mutations and how they affect a person’s risk of cancer. Not everyone may benefit from genetic testing. It is designed for people whose medical history shows the possibility of an inherited gene mutation.
Genetic counselors advise you and your family on identifying and managing any risk of inherited cancer. They work with you and your doctors to perform and review any genetic testing and help you understand the results.
- Health librarian
If you are interested in learning more about cancer, our professional medical librarians can help. We offer free, science-based information on cancer and other health topics at the Stanford Health Library.
- Occupational therapist (OT)
These skilled practitioners provide rehabilitation care to help you regain strength and functional ability during and after treatment for cancer. We help you with activities of daily living such as: - Bathing or showering
- Dressing and grooming
- Using the restroom
- Feeding yourself
- Managing your medications
- Driving
- Physical therapist (PT)
Cancer treatment can affect your strength and mobility, especially in the shoulder and arm. Physical therapists work with you and your family to recover your physical function after treatment, such as improving your: - Strength, especially in the upper body
- Sensation, to relieve numbness in treated areas
- Range of motion, to reduce stiffness and pain
- Movement control, to improve endurance and reduce fatigue
- Registered dietitian (RD)
Team members with specialized training and experience in food and nutrition work with you to understand your preferences and needs. RDs provide education about healthy eating and create a personalized diet to keep you healthy before, during, and after treatment.
- Social worker (SW)
This health professional works with you and your family to provide emotional support, counseling, and resources such as financial assistance, spiritual counseling, and transportation. A social worker can also connect you with community services and, if you’re coming from out of town, help you find a place to stay.
The first appointment with your cancer doctor is an opportunity for you to ask any questions. In your first visit, you will:
- Discuss treatment options, including whether or not radiation treatment is recommended for you.
- Discuss the exact type, number of treatments, and potential side effects of radiation treatment, if recommended.
- Bring any paperwork and imaging done outside Stanford for your doctor to review.
- Be offered your next appointment for a simulation scan in preparation for your radiation treatment (a scan, in treatment position), if appropriate.
A simulation scan is done to get images of the cancer site, with you placed in the exact position you will be during all of your radiation treatments. These images are used to design a radiation plan that is customized to your specific body and anatomy. This appointment usually takes about 1 to 3 hours, depending on the types of scans that are recommended.
Your first visit is also an important opportunity to tell the doctor and care team about your past medical history and all of the medicines you take – even occasionally. Some prescriptions, vitamins, supplements, and herbal remedies can affect how your body responds to radiation therapy, so it is important to tell your doctor about all of them.
We can help you get started with a checklist of what to expect and what to prepare.