External beam radiation therapy is the most common type of radiation given for oral cancer.
Radiation from a source outside the body is usually directed at the tumor site. You may also receive radiation to your neck. This type of radiation may come from a machine called a linear accelerator.
Before you start radiation, you'll need a dental exam, which is usually done by an oncologic dentist (a dentist who specializes in treating patients with oral cancers). If your teeth are in poor condition, the dentist will remove them. If all your teeth need to be removed, your dentist can create dentures for you to wear after the treatment is finished and any swelling has gone down. Removing teeth in bad condition helps prevent radiation damage to your jawbone, called osteoradionecrosis.
Before your first appointment to get radiation, you will have an appointment to learn exactly where on your body the radiation beam needs to be directed, in a process called simulation. The appointment may take up to 2 hours. Here's what you can expect to happen during the simulation process:
You'll lie still on a table while a radiation therapist uses a machine to identify your treatment field, which may also be called your port. The field is the exact area on your body where the radiation will be aimed. You may have more than 1 treatment field if you have cancer in more than 1 place. The therapist will mark your skin with tiny dots of colored semipermanent ink or tattoos. In this way, the therapist can aim the radiation at the same place each time.
You may also have imaging scans, such as CT scans, to help doctors know the exact location of your tumor to better determine the treatment area.
You may also have a face mask or other body molds made. Molds are used to help keep you from moving during the treatments.
You can get radiation as an outpatient at a hospital or clinic. That means you don't need to stay the night. You'll receive a schedule for radiation therapy. The schedule usually is for 5 days a week for 6 to 7 weeks. Spreading out the radiation dose helps protect your healthy tissue. Some patients can be treated with newer techniques that are given twice daily on some or all of the treatment days. They receive better tumor control, but may have more side effects.
On the days you receive radiation treatment, you'll lie on a table while the machine is placed over you. Some radiation centers use a face mask to limit your movement while the radiation is being given. You may have to wear a hospital gown. A radiation therapist may place blocks or special shields to protect parts of your body that don't need to be exposed to radiation. To protect you, the therapist also lines up the machine exactly with your marked treatment fields, located during the earlier simulation. The experience is much like that of getting an X-ray, only it lasts longer (about 15 to 30 minutes for the whole process, with about 1 to 5 minutes of that spent getting the radiation).
The radiation therapist will leave the room to turn on the machine, but you will be able to talk to the therapist over an intercom. You can't feel radiation so it will be painless. You may hear whirring or clicking noises. You will not be radioactive afterward.
Brachytherapy usually comes from an implant placed in or near the cancerous area. The radiation material may be in flexible tubes called catheters or metal rods.
You may need to stay in the hospital for a few days while the treatment is done. You may need to limit the amount of time that people visit you. Pain and nausea are common side effects. These should go away when the treatment is done.
When doctors remove the implant, your body will no longer be radioactive. In the past, doctors sometimes implanted radioactive pellets that would stay in the body permanently. This treatment is no longer popular for oral cancer.