I. What changes will occur in the skin of the radiotherapy area and how to deal with them?
Changes
After several days of radiotherapy, the earliest manifestation of the skin in the radiotherapy area is skin erythema, which is the result of vascular reaction after radiotherapy. As the number of radiation therapy increases the skin in the area of radiation therapy will appear pigmentation and pore enlargement darkening phenomenon, some people will also appear in the irradiated area of the skin blisters, at this time, if not timely stop irradiation, will further development, skin breakage, water and even the formation of ulcers.
The above is what we call skin radiation reaction from mild to severe. Although the surrounding normal skin cells that have not been irradiated will continue to proliferate, repair and heal while radiotherapy is in progress, but for post-operative breast cancer patients, due to the removal of a lot of chest wall tissues, the local tissue blood supply is not very good and radiation reaction is more likely to occur. Therefore, post-operative breast cancer patients should pay more attention to protect the skin in the irradiated field to avoid serious radiation reactions.
Treatment methods
1. The skin should be fully exposed, avoid abrasion, underwear and collar should be soft and clean, and try not to wear chemical fiber underwear.
2.Do not allow sunlight exposure and wind blowing; do not use overheated water for bathing; do not use irritating detergents.
3, can not scratch with hands, otherwise it will make the rupture area larger and not easy to heal.
4. During the irradiation process, you should follow up regularly (once a week) so that your treating doctor can have an understanding of your skin condition. If skin discomfort occurs, such as tingling, itching, blisters, etc., you should promptly inform your treating physician so that he or she can make timely and appropriate treatment of the reaction.
What should I do if the skin in the irradiated area breaks down and flows?
Skin breakdown and flowing water in the irradiated area is a more serious radiation therapy reaction that occurs when the skin is exposed to radiation therapy for a certain period of time, which is the result of the speed of skin cell damage in the irradiated area exceeding the speed of normal skin cell repair. From the patient’s point of view, we should pay attention to fully expose the ruptured area, let the ipsilateral upper limb lift up more when the axillary skin is ruptured, reduce local friction, avoid scratching; underwear should be cotton, soft and clean, try to wear underwear and less chemical fiber underwear; reduce local stimulation, use irritating soap and other toiletries, do not use overheated water for bathing, not exposed to the sun, etc.. And promptly seek medical treatment. The rupture of skin in the irradiated area is a normal reaction to radiotherapy, which can be cured if the patient cooperates with the doctor and receives reasonable treatment.
Can chemotherapy and radiotherapy be used at the same time?
Radiotherapy is a kind of treatment with good effect of local control of tumor, while chemotherapy has the ability to treat almost the whole body. When these two methods are properly combined, they can achieve complementary effects.
There are usually the following cases.
(1) Neoadjuvant chemotherapy
(1) neoadjuvant chemotherapy for radiotherapy-sensitive tumors, where the tumor is large prior to treatment and there are difficulties in setting the radiation field, or the patient’s specific situation cannot be too large. Or considering that there is still a possibility of local spread, several courses of chemotherapy or one course of chemotherapy can be used first, and then radiation therapy can be given after the mass has regressed significantly.
(2) Radiation sensitization
Chemotherapeutic drugs can affect the cellular kinetic properties of tumor tissue after acting on tumor cells, and some of them can affect the molecular biological changes in tumor cells, which can provide favorable conditions for simultaneous radiation therapy and play a greater role in killing tumor cells.
(3) Combined radiotherapy and chemotherapy
Some patients are diagnosed late, and the tumor is not limited to local existence, but also has spread elsewhere. It is difficult to take care of all of them with radiation therapy alone. Chemotherapy alone can not control some local problems well. At this time, planned radiotherapy and chemotherapy should be carried out, and careful arrangements should be made to improve the therapeutic effect.
In conclusion, the simultaneous use of radiotherapy and chemotherapy will play a favorable role in improving the efficacy, but the toxic side effects of both are also worth considering, the most common of which may be blood and skin mucosal reactions.
IV. Common side effects of chemotherapy and how to deal with them
Chemotherapy is different from surgery and radiation therapy in that it is holistic in its treatment of the human body and works throughout the body through oral and intravenous administration. Cancer is the local manifestation of a systemic disease. The greatest threat to the patient is the spread and metastasis. Chemotherapy is an indispensable part of cancer treatment because it is unique in eliminating distant metastasis or preventing recurrence of certain cancers. However, chemotherapeutic drugs are often “unclear” and “indistinguishable”, killing tumor cells and normal cells in the body at the same time. Chemotherapy is also associated with toxic effects and adverse reactions.
So, what are the reactions and how to deal with them?
1.Gastrointestinal reactions: It is often the most serious and worrying side effect of chemotherapy as self-reported by patients. Patients should have a reasonable diet during chemotherapy, not after a full meal or fasting chemotherapy, the best application of chemotherapy drugs in 2-3h after meals; diet should be a small number of meals, chemotherapy should not eat too much and too greasy food. Of course, the doctor will also give anti-emetic drugs 30 minutes before chemotherapy, these drugs will greatly reduce the vomiting reaction. Nausea and vomiting in chemotherapy should be dealt with promptly, and in case of severe vomiting, intravenous nutrition is required.
2, bone marrow suppression: is the most common side effect of chemotherapy drugs. Chemotherapy should be accompanied by leukocyte-lifting drugs as prescribed by the doctor, regular blood recheck, leukocytes below 1.0×10 9 /L, should follow the doctor’s instructions to apply antibiotics prophylactically, implement isolation treatment and care, and limit visits to avoid cross-infection.
Hair loss: The “special image of chemotherapy” due to hair loss is a serious problem that affects the patient’s self-esteem, therefore, the patient should be informed of this possible problem before chemotherapy, so that he or she can be fully prepared. Can wear an ice cap in the chemotherapy process or in the hairline with a rubber strip tied tightly scalp to prevent.
4.Venous injury: the pain of injection and no vein available later is one of the concerns of chemotherapy patients, nursing staff should master the skilled operation technique and rich business knowledge, plan to choose the superficial vein of the affected limb. Skilled manipulation techniques and painless injection skills can reduce patients’ fear of chemotherapy. Patients should also pay attention to the protection of veins during the injection process to prevent drug extravasation. In the event of extravasation of chemotherapy drugs, the injection should be stopped immediately, the doctor and nurse should be informed, and timely local treatment should be performed. For post-operative breast cancer patients, the infusion should be avoided in the vein of the upper limb on the affected side, and post-operative infusion should preferably be carried out on the healthy side.
5, oral mucosal ulcers: since the beginning of chemotherapy, oral hygiene and diet should be paid attention to, at least 4 times daily oral cleaning. Encourage patients to eat nutritious food, drink more water and fresh fruit juice rich in potassium ions, assist patients to develop reasonable recipes, food variety selection, requiring high protein, high calorie and rich in.