Radiotherapy - your questions answered
This is a simple guide to radiotherapy treatment - perfect if you've just been told it's planned for you. While it does not deal with every issue, we hope it will answer some of your questions. It forms part of
Radiotherapy is also called Radiation Therapy, or RadiationTreatment.
Who Will Be Looking After Me?
A specialist cancer doctor is known as a radiotherapist or oncologist
A specialist trained in radiotherapy is known as a radiotherapist. In some cases they may be an oncologist. Hereafter we will refer to him/her as an oncologist. The oncologist will plan and oversee your treatment, which will be carried out by therapy radiographers.
In addition, the team looking after you may well involve a whole range of people including nurses, health care assistants, specialist nurses, counsellors and dietitians, according to your needs during your treatment.
It is a legal requirement for the radiographers to check your name and details against your treatment sheet, every time you attend.
What is Radiotherapy?
Radiotherapy is the treatment of cancer with radiation. This can be done in a variety of ways, depending on the nature of your cancer. The most commonly used method is called external beam therapy (from a machine outside the body), which directs radiation at the tumour. If you are going to have any other type of treatment, you should have been given a separate leaflet describing it.
Radiotherapy is the treatment of cancer with radiation
Female patients must not be pregnant or become pregnant at any time during a course of radiotherapy, or for up to 4 months afterwards. If you think you may be pregnant at any time during treatment, it is extremely important that you discuss this with your oncologist, radiographer or nurse as soon as possible.
How Does Radiotherapy Work?
Although the radiation affects both cancer and normal cells, it has a greater effect on the cancer cells. Treatment aimed at cure will give the highest possible dose of radiation to the cancer area (within safe limits) to attempt to kill all the cancer cells. Sometimes smaller doses are used, where the aim is to reduce the size of a tumour and/or relieve symptoms.
Go to: 20 tips to improve my radiotherapy experience
How is My Treatment Planned?
Every course of radiotherapy treatment is designed to suit the particular needs of the person receiving it, so you will usually be asked to make a preliminary visit to the Cancer Treatment Centre to have your course of treatment planned. The oncologist and radiographers will do this (in conjunction with x-rays and scans, using a machine called a simulator). Your skin will be marked with coloured pens to define where you will have your treatment. In addition, some minute permanent marks will be made using a special dye and a tiny pin prick.
Your skin will be marked with coloured pens to define where you will have your treatment
These marks will enable the radiographers to identify exactly the right area at every treatment session. If a head shell has been made for you (see Helpful Hints on having an immobilisation shell made) the guidance marks will be put on the shell rather than on your skin.
If you are having radiotherapy to your mouth and/or throat you will need a dental assessment at this stage as you may require some dental treatment before you start your radiotherapy.
How is Radiotherapy Treatment Given?
Radiotherapy treatment is given using either a machine called a linear accelerator or, for some skin tumours, a superficial x-ray unit. To receive the radiotherapy, you will lie on a couch and be asked to remain still during the actual treatment.
Consent: It is a legal requirement to have a signed Consent Form from you before the start of your radiotherapy treatment. If you have already been given one of these forms by the oncologist who first advised radiotherapy, please bring the completed form with you when you come for your first appointment. If you have not already been given a form, this will be dealt with at your first appointment.
Will the Radiotherapy Hurt?
No. The treatment is completely painless. Radiation cannot be seen or felt while it is being given.
Will the Treatment Make Me Radioactive?
No. There is no possibility of this whatsoever.
How Long Will My Course of Treatment Last?
Your oncologist will tell you this once the appropriate treatment for you has been decided. A course can last for anything from a single treatment session to five treatments a week for six weeks, depending on a number of factors, e.g. the part of your body being treated and the aim of the treatment.
How Long Is Each Treatment Session?
This varies from machine to machine. Some machines operate at a faster rate than others, and it also depends on the plan worked out for you. The length of a treatment session can be anything from five minutes to fifteen minutes. Occasionally a session may take longer, but this will be explained on an individual basis. When you come for your first treatment your radiographer will tell you how long each session will take.
Do I Have To Stay In Hospital?
If you are able to travel to hospital for treatment, there is usually no need for you to be admitted (during the course). Most people are treated as outpatients, but your oncologist will tell you if it would be better for you to be admitted.
Will I Have Any Tests During Treatment?
During your course of treatment you may need to have occasional blood tests and/or urine tests, depending on the part of your body being treated. Some people also have x-rays and/or scans during their treatment; this is part of the routine and nothing to worry about.
Some Do’s and Dont’s
As far as possible throughout your treatment, try to lead a normal life - try to think of the radiotherapy as an interruption to your daily routine rather than as the most important part of your day. However, the following tips might help:
Drink plenty of fluids every day during treatment.
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Eat regularly and try to keep a balanced diet. if you don’t feel like big meals, try eating little and often. The dietitian can help to plan a diet for you if necessa
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Wash, shower or bath as normal during treatment using a simple or baby soap, taking care to pat dry the area being treated, rather than rubbing it.
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Don't drink spirits, eat spicy food or very hot or very cold food if you are having treatment to your mouth, neck or chest, but ask the radiographers if you would like more information.
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Don’t expose the treated area to the sun during a radiotherapy treatment course, as the treated area will burn more easily and take some time to heal. In the future it is advisable always to apply sunscreen to avoid sunburn.
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Don't put creams or deodorants on the treated area as these may worsen your skin reaction.
Am I Likely To Have Any Side-Effects?
Radiotherapy is a localised treatment, which means that any side-effects will depend on the part of your body being treated.
Although many people have few, if any, side-effects, everyone reacts differently and during your treatment you may experience one or more of the following:
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Tiredness (fatigue) You may feel tired and lethargic during your treatment and especially towards the end of the course and after it has finished. This is very common, and can last a variable length of time. If it happens to you, pace yourself and rest as much as you feel you need to and gradually the tiredness will pass, although it may take a long while.
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Tender skin During your treatment and especially towards the end of your course, your skin in the area being treated may turn red, like mild sunburn, and tenderness and redness may even increase for a week or two after your treatment has finished. (This is because the tissues continue to be affected by the x-rays for several weeks after treatment.) It will gradually recover, but the nurse or radiographer treating you will explain exactly how you should look after your skin, during and after your course of treatment.
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Sickness Depending on the part of your body being treated you may feel nauseous or be sick during your course of treatment. This does not happen to everyone. If you do feel sick, please tell your radiographer or nurse as it can be controlled by tablets or diet.
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Diarrhoea Again, depending on the part of your body being treated, you may experience some diarrhoea. Please tell your radiographer or nurse if this happens to you as you may need diarrhoea-relieving medication. The dietitian will also be pleased to advise you and help you with an eating plan if necessary.
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Frequency when passing urine If you are having treatment to your lower abdomen/ pelvis you may find that you pass urine more often and may experience discomfort when doing so. Drinking extra fluids will help, but try to avoid alcohol, tea and coffee as these can irritate your bladder. If this happens to you please tell the staff treating you, so that your urine can be tested for any infection, which could then be treated with appropriate medication.
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Sore mouth and throat This only happens if you are having treatment to this part of your body. If it is likely to be a problem your radiographer or nurse will explain how to look after your mouth and throat.
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Hair loss Hair loss only occurs where treatment is given. For example you will only lose the hair on your head if your head is being treated, and if your chest is being treated, then you will only lose your chest hair. Whether or not it grows again will depend on how much radiation you have been given. Your oncologist will explain what this means for you. If your hair is expected to grow again, this should happen within a few months of the end of your treatment.
Can I Carry On Working?
Do ask if you need advice
If you feel you wish to carry on working, as long as your oncologist agrees, there is no reason why you should not continue with your normal daily routine throughout your course of treatment. However do ask if you need advice.
What Will Happen When My Treatment Has Finished?
The immediate side-effects of the treatment described above will start to ease off within a week or two of the end of your course. Because of the way radiotherapy works, the full benefit of the course of treatment is not usually reached until some weeks after the last treatment session.
Will I Have Any Check-ups After My Treatment?
After your treatment you may be seen again at the hospital you first attended or be referred back to your GP (family doctor).
The first follow-up is usually about 4 to 6 weeks after the course has finished
The first follow-up is usually about 4 to 6 weeks after the course has finished, and this appointment will be discussed with you before you finish at the treatment centre. However, follow-up arrangements can vary from person to person. Your oncologist will explain to you, how and where your follow-up appointments will be arranged.
Can Radiotherapy Cause Permanent Damage?
Unfortunately, yes. Radiotherapy treatment is planned and delivered with the utmost care, but sometimes sensitive parts of the body are damaged. This is because to treat the cancer effectively, it is sometimes necessary to use high doses of radiation, close to the limits that normal tissues can withstand. The bowel, bladder and nervous system are particularly sensitive, but other parts of the body can suffer long term changes.
If you are having radiotherapy aimed at killing your cancer cells, the official line is that there is a 5% possibility of side-effects which may seriously affect your lifestyle. However, it is important to balance this against the much higher potential risks to your life from the cancer getting worse or recurring without the treatment. On the other hand, if you are having radiotherapy to shrink the tumour and/or relieve symptoms, then the much lower doses of radiation used are unlikely to cause any permanent damage.
If you do have any difficulties at any time in the future which you feel may be connected with your radiotherapy, then do not hesitate to contact your oncologist or GP. If there are any special risks or problems in your case then your oncologist will discuss this with you. Bear in mind that you are being offered radiotherapy because the benefits greatly outweigh the risks.
There is a 'Lifetime Radiotherapy doseage' and for this reason it is extremely unlikely that once a radiotherapy course is completed, you will ever be offered it again in the same area.
It should be noted that an Action group called RAGE believe 25% of people having traditional radiation therapy suffered side-effects from damage to the backbone to lung damage. The reason is that the beam damages tissue before and after the targeted cancer, and the beam spread around the target area.
However, over the years radiotherapy has become incresingly better targetted.
Are there safer modern forms of Radiotherapy?
1. Gamma Knife:
The Gamma Knife is not a knife but a very tightly targeted radiotherapy particularly useful for brain cancer in adults and children. It concentrates gamma radiation over a very small area causing less damage. It can also be refered to as Electro-radiation or radiosurgery.
2. Cyberknife
This robotic delivery system allows an attack on the tumour, however deep, from multiple anles. The theory is that it always tightly targets the tumour location, but because the beam attacks from multiple angles, the damage before and after the tumour is far less. Proponents refer to it as 'non-invasive'. This is actually untrue. Less invasive on any secondary issues would be a more correct phrase.
3. Proton Beam Therapy.
Since 2005 MD Anderson have been using this breakthrough. Protons are pulsed at the target, achieving the same results but with no damage before or after the tumour and far less scatter. It has been used effectively for almost all cancers, notably brain cancer, children's cancers and prostate cancer.
Go to: Proton Beam Therapy overview