How does radiation work to treat cancer?

Radiation is energy that is carried by waves or a stream of particles. Radiation works by damaging the genes (DNA) in cells. Genes control how cells grow and divide. When radiation damages the genes of a cancer cell, it can’t grow and divide any more. Over time, the cells die. This means radiation can be used to kill cancer cells and shrink tumors.

To understand how radiation works as a treatment, it helps to know the normal life cycle of a cell. The cell cycle goes through 5 phases, one of which is the actual splitting of the cell. When a cell splits, or divides, into 2 cells, it’s called mitosis.

The cell life cycle

The cell cycle

G0 = Cell is resting

G1 = RNA and proteins are made

S = DNA is made

G2 = Apparatus for mitosis is built

M = Mitosis (the cell divides into 2 cells)

G0 phase (resting stage): The cell has not yet started to divide. Cells spend much of their lives in this phase. Depending on the type of cell, this step can last for a few hours or many years. When the cell gets the signal to reproduce (divide), it moves into the G1 phase.

G1 phase: During this phase, the cell starts making more proteins to get ready to divide. Single strands of DNA, called RNA, are also made. This phase lasts about 18 to 30 hours.

S phase: In the S phase, the chromosomes that contain the genetic code (DNA) are copied so that both of the new cells to be made will have the same DNA. This phase lasts about 18 to 20 hours.

G2 phase: The G2 phase is just before the cell starts splitting into 2 cells. It lasts from 2 to10 hours.

M phase (mitosis): In this phase, which lasts only 30 to 60 minutes, the cell actually splits into 2 new cells that are exactly the same.

The cell cycle and radiation

The cell cycle phase is important in cancer treatment because usually radiation first kills the cells that are actively dividing. It doesn’t work so fast on cells that are in the resting stage (G0) or are dividing less often. The amount and type of radiation that reaches the cell and the speed of cell growth affect whether and how quickly the cell will die or be damaged. The term radiosensitivity describes how likely the cell is to be damaged by radiation.

Cancer cells tend to divide quickly and grow out of control. Radiation therapy kills cancer cells that are dividing, but it also affects dividing cells of normal tissues. The damage to normal cells causes unwanted side effects. Each time radiation therapy is given there needs to be a balance between destroying the cancer cells and minimizing damage to the normal cells.

Radiation does not always kill cancer cells or normal cells right away. It might take days or even weeks of treatment for cells to start dying, and they may keep dying off for months after treatment ends. Tissues that grow quickly, such as skin, bone marrow, and the lining of the intestines are often affected right away. In contrast, nerve, breast, brain, and bone tissue show later effects. For this reason, radiation treatment can have long-term side effects that might not be seen until long after treatment is over.

In the past, it was thought that once an area was treated with radiation it could not be treated with radiation again because of damage to the normal cells in the treatment area. But research suggests that a second course of radiation therapy can be given to some patients.