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Radiation therapy or radiotherapy is the use of various forms of radiation to safely and effectively treat cancer, to control the growth of the cancer or to relieve pain. The goal of radiation therapy is to get enough radiation into the body to kill the cancer cells while preventing damage to healthy tissue. Depending on the location, size and type of cancer, high-energy particles or waves, such as X-rays, gamma rays, electron beams or protons are used to destroy or damage cancer cells. Radiation therapy works by damaging cancerous cells. Normal cells are able to repair themselves, whereas cancer cells cannot. 

Radiotherapy uses high-energy rays that can be given both externally and internally to treat the disease.  

  • External radiotherapy - It aims high energy X-rays at the affected area. During external beam radiation therapy, a beam of radiation is directed through the skin to the cancer and the immediate surrounding area in order to destroy the main tumor and any nearby cancer cells. This allows doctors to get enough radiation into the body to kill the cancer while giving healthy cells time each day to recover.
  • Internal radiotherapy - It involves having radioactive material placed inside the body.

Radiation may be used to make your primary treatment more effective.

  • Curative or Radical treatment - This is given with the aim of destroying a tumour that has not spread to other parts of the body and thus curing the cancer. Curative treatment may be given on its own or it may be given before or after surgery or chemotherapy. One can be treated with radiation therapy before surgery to help shrink the cancer and allow less extensive surgery than would otherwise be needed; or one may be treated with radiation after surgery to destroy small amounts of cancer that may have been left behind. Sometimes, the overall goal is to slow down the cancer as much as possible.
  • Palliative treatment - In some cases, when it’s not possible to cure a cancer, the goal is to reduce the symptoms caused by growing tumors and to improve one’s quality of life. Lower doses of radiotherapy are given for palliative treatment to relieve pain over a shorter period of time to shrink the tumour.

Radiation therapy is safe and effective & has been used successfully to treat patients for more than 100 years. Treatment is carefully planned to focus on the cancer while avoiding healthy organs in the area. Special computers are also used to monitor and double checking of the treatment machines is done to make sure that the proper treatment is given.

IMRT is an advanced mode of high precession radiation. In IMRT the radiation beams are subdivided (modulate) into many beamlets aimed at the tumour, from various directions. Also, intensity of each of these beamlets can be adjusted individually. Thus, it is specialized form that allows radiation to be shaped exactly to fit the tumour. Using IMRT, it is possible to further limit the amount of radiation that is received by healthy tissues near the tumour as compared to 3D-CRT. In many situations this may also allow relatively higher dose of radiation to be delivered to the tumour, increasing the chance of cure. As this method of treatment delivery is very accurate, proper positioning of the patient becomes crucial. The planning of IMRT procedure takes 2-4 days after the immobilization and the imaging procedure. With a good computer based inverse planning methodology and rigorous OA, IMRT is complete.

Image Guided Radiation Therapy or IGRT helps to improve the delivery of radiation. IGRT involves conformal radiation treatment guided by a CT scan (called Cone Beam CT), taken in the treatment room just before the patient is given the radiation treatment. IGRT is one of the most advanced form of radiotherapy. The imaging information from the planning CT scan done earlier is overlapped on this Cone Beam CT. With this technique, movements of tumour breathing or reduction in size can be tracked. Also, even the variation in millimeters in daily positioning of the patient is detected and corrected instantly. Treatment with respiratory gating is used for tumours that move during respiration such as lung and liver.

Stereotactic Body Radiotherapy or SBRT is an immerging image guided radiation method. SBRT is directed to extremely well defined targets within the body. SBRT delivers very high doses of radiation precisely to tumours sites within the body with the purpose of improving local control and limiting side effects. SBRT is appropriately used for small lung cancers or metastasis, small liver tumours or bony tumours and tumours in other sites that may not be appropriate for surgical resection or in patients who would not be candidates for surgery. SBRT is generally completed in 3-5 treatment fractions. At times, small gold fiducial markers are implanted with minimally invasive techniques to provide Stereotactic image guidance during radiation therapy. 3D imaging (CT, CT/PET, CT/MR) is used to construct very precise plans minimizing radiation dose to normal structures.

Tumours are not regular, they come in different shapes and sizes. Three dimensional conformal radiation therapy, or 3D-CRT, uses computers and high definition software with special imaging techniques to map the size, shape and location of the tumour. Computer Assisted (CT scans), Magnetic Resonance Imaging (MR scans) and/or Positron Emission Tomography (PET scans) are used individually or by fusion to create detailed three dimensional representations of the tumour and the surrounding organs. This therapy uses a multileaf collimator (MLC) to precise radiation beam to targeted area. As the radiation beams are very precisely directed, adjacent normal tissues receives less radiation and are able to heal quickly. 

This is conventional treatment offered using linear accelerator where patients undergo CT scan based planning and port film with the technique which has the latest high resolution amorphous silicon portal imager for this purpose.

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