Radiotherapy

What is radiotherapy?

Radiotherapy uses radiation to kill cancer cells or injure them so they cannot multiply. Radiotherapy can be used to treat the original (primary) and to treat the symptoms of advanced cancer. While radiation will affect all cells, normal cells are better able than cancer cells to resist or recover from its effects.

- Radiotherapy will not leave you radioactive.
- The treatments do not hurt.
- The radiation is not hot.
- You will not see or feel the rays, just as you do not see or feel anything when you have an ordinary x-ray.

Why radiotherapy is used?

- To cure cancer
- To control cancer
- To relieve symptoms
- To help other treatments

How long is a course of treatment?

Different people need different numbers of radiotherapy treatments. Usually people need radiotherapy five days a week for several weeks.

Using many small doses of daily radiation rather than a few large doses helps protect normal body tissues in the treatment area. Weekend rest breaks allow normal cells to recover. Each dose of radiation causes a little more damage to cancer cells, so it is important to attend all your treatments to ensure you receive enough radiation to eventually kill the cancer cells. You may not notice any benefit until some time after the treatment finishes.

Preparing for treatment

Planning Procedures
1. Examination: Your radiation oncologist will examine you and may ask for further x-rays and other tests to find out more about your tumour will then decide which part of the body to treat and how much radiation to use.
2. Simulator: A special x-ray machine called a simulator is often used to precisely pinpoint the area of the body to be treated.
3. Moulds and casts: Depending on the type of treatment you will be receiving, special support devices may be made to help you stay still during treatment and to make sure the treatment is directed at the same place each time.
4. Skin marking: The doctor or radiation therapist may mark your skin with special ink or marker pens to make sure the radiation is directed at the same place on your body each time.

What happens during treatment?

You will probably be asked to change into a hospital gown and you will be taken into a special treatment room. You might be in there for 15 or 30 minutes, although you will only get radiation for about one to five minutes of that time, depending on the dose the doctor has prescribed. The radiation therapist will settle you on the treatment table or in a chair. If you have had a special support device made, it will be used during your treatment.

The therapist will spend a little time getting the machines in exactly the right place and checking all the required steps. The machines make noises like a vacuum cleaner as they move around to aim at the cancer from different angles. The machines are always under the radiation therapist's control, and you will not hear or see the rays.

Once everything is in place, the radiation therapist will go to a nearby room to turn on the machine. You will be alone in the room, but you can still talk with the radiation therapist through an intercom, and he or she will watch you all the time on a television screen or through a window.

You may breathe normally during treatment but it is important for you to stay very still while the machine is working. Some people may need treatment from several different angles, so the radiation therapist will move you or the machine before repeating the procedure. The radiation therapist will tell you when it is time to move.

You should not feel any discomfort. If you are concerned or anxious at any stage, or if you feel unwell, always request the radiation therapist to explain or help. While you are having your course of treatments, your doctor will watch over your progress, checking the cancer's response to treatment and your overall well-being. This may involve physical examinations, blood tests, scans and x-rays.

Does it hurt?

No, it does not hurt. You will not see or hear the radiation and you should not feel any discomfort during the treatment.

Will I be radioactive?

No. External radiotherapy does not make you radioactive. It is safe to be with other people in the period when you are having treatment and afterwards.

Managing side effects

Radiotherapy is an effective treatment for many cancers, but it can cause unwanted side effects. Side effects usually start around the second or third week of treatment and are at their worst two-thirds of the way through treatment. Fortunately, most side effects will go away in time and there are ways to reduce the discomfort they may cause.

Side effects vary:
- from person to person - some people will have no side effects, others will experience a few
- from the areas of the body being treated
- from one treatment period to the next

The type and severity of your side effects have nothing to do with the success of your treatment.

Helping yourself during radiotherapy
- Talk to your radiation oncologist about possible side effects. Before your treatment begins ask your doctor about the expected short term and long-term side effects.
- Tell your doctor or nurse of any side effects. If you have a particularly severe side effect, the doctor may prescribe a break in your treatments or change your treatment.
- Ask your doctor if you can take any medicines, creams, home remedies or alternative or complementary therapies. Some of these remedies can affect how radiotherapy works in your body.

Side Effects and Tips

1. Feeling tired and lacking energy
Tips:
- Save your energy. Help your body by doing less and doing restful things in your leisure time.
- Try to get more sleep at night and take naps during the day if you can.
- Let other people help you. Family members, neighbours and friends may be glad to have a chance to help you with tasks like shopping, child-care, housework and driving.
- Take a few weeks off work during or after your radiotherapy, or work fewer hours. May be you can do some of your work at home. Some people feel well enough to continue to work full time if their treatment appointments can be organised to suit their work hours.

2. Skin problems
Tips:
- Wear soft clothing. Some of the dye marks may rub off on your clothes, so it is best to wear loose and comfortable older clothes that you can throw out if they get stained.
- Avoid wearing tight clothes such as girdles or close-fitting collars that may irritate the skin.
- Protect the treatment area from the sun. Stay out of the sun and, before going outdoors, always cover your treated skin with light, close-weave clothing. Ask your doctor about using a sunscreen (SPF 30+).
- Tell your doctor about changes in your skin, such as cracks or blisters, very moist skin, rashes, infections or peeling, or any changes in your nails.
- Do not rub, scrub or scratch treated skin or any sensitive spots. Let the dye outlines after your treatment wear off gradually.
- Avoid using any soaps, creams, deodorants, medicines, perfumes, cosmetics, talcum powder or other substances on the treatment area without your doctor's approval. Many products leave a coating that can interfere with radiotherapy.
- Bath or shower in lukewarm water - hot water can injure your sensitive skin. Pat skin dry with a soft towel. Do not put very hot or cold things (hot-water bottle, ice pack, etc...) on the treatment area.
- Do not use a blade razor on the treatment area. Check with your doctor or nurse before using an electric razor.

3. Hair loss
Tips:
- Wear a wig or hat, scarf or turban. Do whatever feels comfortable and gives you the most confidence.
- If you plan to buy a wig, it is a good idea to choose it early in your therapy so you can match the colour and style of your own hair.
- If you prefer to leave your head bold, protect it against sunburn or extreme cold.
- Expect the hair that first grows back to be a little different. It might, for instance, be curly although you have always had straight hair. In some people, it will be a little thinner and, occasionally after a large dose of radiotherapy, the new growth can be patchy for a while.
- Look after your scalp the same way as other treatment areas anywhere else on your body.
- Ask your hairdresser to make your hair look as good as possible even if it is thin or patchy. In time, your hair will probably return to its normal condition and you can resume your usual hair care routine.

4. Loss of appetite
Tips:
- Eat smaller amounts but more often.
- Try to catch up on days when you do feel like eating.
- You may find that you can drink a lot, even if you do not feel like eating solid foods. If so, try enriching your drinks with powdered milk, low-fat yoghurt, eggs, honey or weight-gain supplements. The hospital dietitian will also be able to help if you have problems with food.

5. Nausea and diarrhoea
Tips:
- Ask your doctor to prescribe medicine to relieve diarrhoea.
- Check with your doctor, radiation therapist or nurse before taking any home remedies during your radiotherapy treatment.
- Eat nothing or only a bland snack such as toast, dry biscuits or apple juice for a few hours before your treatment. If the problem persists, you can ask your doctor for medicine to prevent nausea.
- Try having nothing but clear liquids as soon as diarrhoea starts, or when you feel it is going to start. Liquids that will not make your diarrhoea worse include apple juice, peach nectar, weak tea and clear broth.

6. Face, mouth, neck and upper chest problems
Tips:
- Suck ice chips and sip cool drinks.
- Avoid tobacco and alcohol (including mouthwashes containing alcohol) because they will dry your mouth even more.
- Ask your doctor or nurse for information on artificial saliva preparations.
- If eating is uncomfortable or painful, ask your doctor for something to relieve the pain.
- Try to have more liquids or soft food if chewing and swallowing are painful.
- Your doctor may advise you to try a diet supplement. You can buy these at a pharmacy without a prescription and many are available in a variety of flavours. You can use them alone or with other foods, such as pureed fruit.
- If your sense of taste changes during radiotherapy, try different ways of preparing food. For example, lemon juice makes many foods, including meat and vegetables, tastier.

7. Dental problems
Tips:
If you are having radiotherapy to your mouth, your teeth will be more likely to decay. If possible, discuss dental care with your doctor before treatment starts, and tell your dentist about your treatment, so that the doctor and dentist can discuss any dental work you need before radiotherapy begins. Your dentist will probably want to see you often during your radiotherapy. He or she will give you detailed instructions about caring for your mouth and teeth, to help prevent tooth decay and to deal with problems such as mouth sores.

8. Fertility problems

a. For women
Radiotherapy to the pelvic area may cause periods to become irregular for a short time or to stop completely (menopause). The signs of menopause include hot flushes, sweating, particularly at night, and dry skin. Talk to your doctor about medication for relieving symptoms of menopause. Early menopause (between the ages of 45 and 55) may cause bones to become weaker and break more easily. This is called osteoporosis.

b. For men
Radiotherapy to an area that includes the testes may reduce sperm production temporarily or permanently. If you want to father a child, you may consider having sperm stored before your treatment starts so that artificial insemination will be possible later. If the testes are outside the treatment area, they can usually be protected from the radiation.

c. Contraception during treatment
Although radiotherapy reduces fertility, it is possible for some women to become pregnant while having radiotherapy and a man having radiotherapy could make his partner pregnant. Pregnancy should be avoided during radiotherapy just in case the x-rays might harm the eggs (ova) before conception or the unborn baby. Radiotherapy to a man may cause him to produce abnormal sperm. You and your partner are strongly advised to use contraception if pregnancy is a possibility. If you or your partner become pregnant, talk to your doctor urgently.

d. What about my sex life?
Men and women usually find that radiotherapy to the pelvic area causes sexual intercourse to become temporarily uncomfortable and undesirable. In women the vagina may feel dry, itchy or burning. If you have these problems you should tell your doctor or nurse, because the symptoms can usually be relieved quickly and easily.

Radiotherapy to the pelvic area can also cause a woman's vaginal tissues to shrink, making sexual intercourse painful. These changes are permanent and can become progressively worse. However, regular intercourse, the use of an instrument to expand the vagina (a dilator) and vaginal lubricants can stop the deterioration.