Radiotherapy

Introduction

Radiotherapy is a commonly used treatment for many different cancers. It uses high-energy X-rays and works by damaging cancer cells in the part of the body being treated.  Radiotherapy is often used in conjunction with other treatments, such as surgery and chemotherapy.

Why am I having radiotherapy?

Radiotherapy is usually used to treat cancer. It may also be used to treat some non-cancerous tumours and other benign diseases - such as thyroid disease (radioiodine treatment).

In the treatment of cancers, radiotherapy is very important.

There are different types of treatment:

• Radical radiotherapyis when radiotherapy is used as the main treatment and aims to cure the cancer(for example, early-stage prostate cancer)
• Adjuvant radiotherapyis when radiotherapy is used in addition to surgery, to shrink a tumour or to reduce the chances of the cancer recurring
• Palliative radiotherapyis when radiotherapy is used to relieve certain symptoms of cancer(for example bone pain) or to prolong life

Radiotherapy may also be used along with chemotherapy. 

There are two main ways of receiving radiotherapy:

1. External beam radiotherapyis the commonest type of radiotherapy and is sometimes called teletherapy.  It involves the use of carefully measured doses of radiation (X-rays) which are beamed by a machine on to the parts of the body where they are needed.  External radiotherapy is normally given as a course of treatment over days or weeks.
2. Internal radiotherapynormally involves a stay in hospital and can be given in several different ways:

Brachytherapyis when radioactive 'seeds' or wires are placed inside or near to a tumour. This means that for a carefully measured period of time, a high dose of radiation is delivered directly to the cancer and damage to nearly organs and tissue is reduced.  Brachytherapy may be used to treat cancers including those of the prostate, oesophagus, lung or gynaecological cancers such as cervical and ovarian

Unsealed source therapyused a liquid source of radiation.  It can be taken orally or given as an injection.  For this type of radiotherapy, you will need to stay in hospital for a few days

How does radiotherapy work?

The high doses of radiation work by damaging the cells in the part of your body being treated. This prevents them growing and dividing.

The normal healthy cells repair themselves quickly, but the abnormal cancer cells are unable to do this and are wiped out. The radiotherapy treatment is carefully planned, so as few normal cells as possible are damaged.

Will there be side effects?

This depends on which part of your body is being treated by radiotherapy and the dose of radiation you are given. Radiotherapy affects people in different ways, so the side-effects can be different for each person.

The common side-effects of radiotherapy are:

• Tiredness and anaemia
• Breathlessness
• Sore skin and sensitivity to sun
• Sore, dry mouth and problems eating
• Diarrhoea
• Nausea

Many side effects are temporary although some people do find that they continue feel fatigued for a few months after treatment. It is important to talk to your specialist team about possible side effects and prepare for them in advance.

Will it hurt?

Radiotherapy treatment is painless.

What is treatment planning?

Your course of radiotherapy needs to be planned specifically for you.  When treatment is given, it is important that you lie in the correct position.

You may need an 'immobilisation device' in order to help you do this comfortably (this could be a moulded cushion, an arm rest or a shield or shell).

The tumour target also needs to be marked so each treatment is given to exactly the right area.  This may be done with a barely visible tattoo or a special pen. 

What do I have to do to prepare for radiotherapy?

You don't normally need to make any special preparations and you can eat and drink normally.

How long does it take?

Courses of treatment can vary from one single dose to a course of twenty or thirty treatments (called 'fractions') over a number of weeks.  It is quite normal to have radiotherapy as an outpatient.

What happens on the day?

You may have to take off some of your clothes and put on a hospital gown.

You will lie on the couch and, using the markers on your skin, you will be put into the correct position under the radiotherapy machine (this can take some time for initial treatments).

You will need to stay in this position during the treatment. Try to relax and breathe normally.

Once you are ready, the radiographers leave the room.  They will watch you throughout your treatment and you can talk to them through an intercom.  When the machine is switched on, there will be a loud buzzing noise.

Will I be radioactive?

No.  External beam radiotherapy doesn't make you radioactive and you can carry on with life as normal.

In some case, internal radiotherapy may make you radioactive for a few days, so as a safety measure, you may be kept away from others (particular children and pregnant women) for a couple of days to reduce their exposure to radiation.

Will I feel OK afterwards?

As soon as it is over, you will be able to get dressed and leave to go home. 

As treatment progresses, you may begin to feel tired and find yourself having days when you feel 'down'.  This is normal.  Accept any offers of help that you get from friends and relatives and try to keep yourself healthy.

Tips to speed recovery:

• Make sure you eat a healthy diet, even if you don't have much appetite
• Get lots of rest
• Give up smoking
• Tell the radiographers or your doctor about any side effects you have as they will probably be able to offer advice

Will my skin be sore after radiotherapy?

Your skin may become red and sore after treatment (a little like sunburn).  Your specialist team will be able to give you advice on how to care for it.

It's important to avoid irritation to the skin so don't use creams or dressings that haven't been prescribed.

Using deodorants or perfumed products on the area of skin affected by radiotherapy can cause reactions. You should also avoid soaking the skin in very hot water.

You should also protect your skin from sun and wind burn by using a sunscreen. Your radiotherapist will be able to give you advice on which to use.

Will I lose my hair?

You will only lose your hair if it is inside the treatment area.  You will be told of this before treatment begins.

Will it affect my sex life?

This depends on where the radiotherapy treatment took place.

If a woman has external or internal radiotherapy to the pelvis, this can affect the ovaries and may cause the menopause.  Radiotherapy to the vaginal area may make the vagina narrower. Sex after radiotherapy can be more uncomfortable while side effects last.

Occasionally, after radiotherapy to the bladder or prostate, men may find it more difficult to get an erection. This can develop months or years after radiotherapy has been completed.

Clickthrough information and support links:

Cancer Research UK

Cancer Backup

Macmillan Cancer Support

Marie Curie Cancer Care

Cancer North Network