SKIN

The greater the energy of the treatment machine the greater the amount of skin sparring

Acute reactions of the skin (usually occur around 20 Gy) :

• Erythema – redness
• Dry desquamation – flaking skin, peeling, itching
• Moist desquamation – skin has broken down / risk of infection
• Patient must see the doctor
• Patient is put on rest
• Epilation – lose of hair ( after 60 Gy hair may or may not grow back)

*acute reactions make the patient uncomfortable

Late / chronic effects on the skin (latent) :

• Hyperpigmentation – tanning (breast patients)
• Atrophy – skin shrinks / lack of pigment / weaker than normal skin
• Telangectasia – red marks from broken blood vessels
• Late ulceration – skin breaks down / tissue may become necrotic (must have a skin graft)

How to reduce skin reactions :

The Do’s and Dont's for skin :

Don’ts :

• No soap
• No deodorant
• No alcohol based products
• No sun exposure
• No ice / heat
• No shaving
• NOTHING ON THE SKIN
• No tight fitting clothing

*each site has protocols for what the patient CAN use (ex. Cornstarch, lanolin, sylvadin)

skin reactions are more likely if :

• Patient is fair skinned
• Treating where the are skin folds
• Use of bolus
• Electron beams

Mucosa

Mucosa is effected in :

• Head and   neck patients

•  Gastrointestinal patients

Head and Neck patients (upper mucosa) :

•  We treat head and necks with high doses

•  Irregular topography of the head and neck

Effects the salivary glands:

(Saliva – prevents cavities, breaks down carbs, taste buds)

•  Treating with radiation changes the ph of the saliva

•  Patient gets lots of cavities and loses weight

do’s and don’ts :

DON’TS :

•  No alcohol or smoking   (causes vasoconstriction and prevents healing)

•  No spicy or rough textured food

•  No coffee

•  No mouthwash

DO’s

•Use baking soda / peroxide as mouthwash

•  Frequently brush teeth with a baby tooth brush only

 

Late results of irradiating mucosa :

•  Fibrosis – nonfunctioning mucosa

•  Dry mouth

Gastrointestinal Patients (G.I. mucosa) :

Small bowel – the lining of the small bowel is extremely sensitive to radiation

•  Small amounts will make the patient very sick

Ways to reduce how sick the patient gets:

•  Use of a bellyboard or small bowel sling to reduce the amount of radiation the small bowel receives

•  Reduce the intake of ruffage and eat carb rich foods / no greasy foods

•  Keep fluid intake up

•  IMRT reduces the volume that the small bowel receives

 

•  there are no late effects on the small bowel because once you exceed tolerance the patient will die

 

Medications :

Compazine – for nausea and vomiting

Lomatil – for diharrea

*A lot of treatments effect the small bowel – hodskins, testicular, colon, prostate, anything in the abdomen!!!

Skin

WBC’s are extremely radiosensitive

RBC’s are effected towards later treatments

Blood counts are taken weekly on patients

Formed elements of the blood :

Erythrocytes (RBC’s) : 6 million per cc

•  transport of oxygen

•  hemoglobin binds O2 to cell

•  anemia – is deficiency of O2 binding (low RBC’s) patients becomes pale, weak, blue under the nails

•  RBC’s have a lifespan of 4 months so we really don’t see the effect on the RBC;s during treatment

•  We do not treat RBC producing parts of the body such as the head of the femur or humorus

 

Leukocytes (WBC’s) : 5000 – 10000 per cc

Many different types of WBC’s

Differential – tells how many of each WBC

•  If WBC count falls below 2000 the patient is put on rest

•  WBC count will fall if:

•  The field is big (because more lymphatic in the field

•  If you treat the lymph nodes

•  Treat the spleen (must be tested every day)

•  If patient is also receiving chemo

Therapist must check to see that WBC count is checked!!!

Thrombocytes (platelets) : 250000 – 500000 per cc

•  Sensitivity is in between RBC’s and WBC’s

•  Platelet count will drop before the RBC count drops (this is useful in patients with leukemia because the WBC can’t be tested)

Thrombocytosis – too many platelets

Thrombocypenia – too little platelets (causes hemorrhaging)