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What is Radiotherapy?
Radiotherapy is the use of high energy x-rays and similar rays (such as electrons) to treat disease.
Since the discovery of x-rays over one hundred years ago, radiation has been used more and more in medicine, both to help with diagnosis (by taking pictures with x-rays), and as a treatment (radiotherapy). While radiation obviously has to be used very carefully, doctors and radiographers have a lot of experience in its use in medicine. Many people with cancer will have radiotherapy as part of their treatment. This can be given either as external radiotherapy from outside the body using x-rays or from within the body as internal radiotherapy. Radiotherapy works by destroying the cancer cells in the treated area. Although normal cells can also be damaged by the radiotherapy, they can usually repair themselves. Radiotherapy treatment can cure some cancers and can also reduce the chance of a cancer coming back after surgery. It may be used to reduce cancer symptoms. Some people find that the side effects are very mild and that they just feel tired during their course of radiotherapy treatment. External beam radiotherapy External radiotherapy is normally given as a series of short, daily treatments in the radiotherapy department, using equipment similar to a large x-ray machine. The treatments are usually given from Monday to Friday, with a rest at the weekend. Each treatment is called a fraction. Giving the treatment in fractions ensures that less damage is done to normal cells than to cancer cells. The damage to normal cells is mainly temporary, but is the reason why radiotherapy has some side effects. The number of treatments you have depends on several factors, including: your general health the type of cancer being treated and where it is in the body whether or not you have had, or are going to have, surgery, chemotherapy or hormonal therapy as part of your treatment. For these reasons, treatment is individually planned for each patient, and even people with the same type of cancer may have different types of radiotherapy treatment. External radiotherapy does not make you radioactive, and it is perfectly safe for you to be with other people, including children, throughout your treatment. A course of curative (radical) treatment may be given every weekday for two to seven weeks. There are several different types of radiotherapy machines that work in different ways. Radiotherapy treatment for most cancers, apart from skin cancers, is given by machines called linear accelerators (LinAcs). The type of radiotherapy machine used will be carefully chosen by your specialist and physicist to give you the most appropriate treatment. Some machines are quicker than others and may give treatment in a very short time, such as a few seconds. Usually, radiotherapy treatment (including the time taken to position you) takes 10–15 minutes or less on any type of machine. The radiotherapy machine does not normally touch you, although for some types of cancer it may press against your skin. If you have a specific type of radiotherapy known as electron treatment, a small applicator may be used, which touches a small area of skin. The treatment itself is painless, although it may gradually cause some uncomfortable side effects. Radiotherapy affects people in different ways; some find that they can carry on working, only needing time off for their treatment, while others find it too tiring and prefer to stay at home. If you have a family to look after, you may find that you need extra help. Don't be afraid to ask for help, whether it's from your employer, family or friends, social services, or the staff in the radiotherapy department. As your treatment progresses, you will have a better idea of how it makes you feel, so you can make any necessary changes to your daily life. Where possible, the radiotherapy staff will try to give you an appointment for the same time each day. This allows you to get into a regular routine. Linear Accelerator This is a linear accelerator (Linac). It is source of powerful x-rays. The x-rays used for treatment have energies between 4 MeV and 20 M eV. This is one obvious reason why an x-ray treatment machine is much bigger than the machine used to take a chest x-ray. The name linear accelerator comes from the fact that electrons are produced in the machine and accelerated in a straight line. They then smash into a metal target within the machine and, because the energies involved are so high, produce high energy x-rays. These are then focussed by the machine into a precisely defined beam that is used for treatment. Modern radiation therapy is a triumph of precision engineering. The gantry can be rotated through 360o and positioned with an accuracy of 1/10 of a degree. Every time we treat a patient we take this technological miracle for granted. We tend to make light of all of this. We don't want to intimidate patients. Facing cancer is daunting enough, people don't want to blinded by science and wizardry. It is, perhaps, worth gently pointing out that day in and day out, and with minimal fuss, we deliver effective treatment of the greatest sophistication and complexity. We try to make the barely possible seems ordinary. Giving your consent Before you have your radiotherapy, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:the type and extent of the treatment you are advised to have the advantages and disadvantages of the treatment any other treatments that may be available any significant risks or side effects of the treatment. If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations. It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment. Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions. You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you. You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice. Possible pregnancy Women of childbearing age will be asked whether they could be pregnant, as x-rays given during pregnancy could harm a baby. If you think that you may be pregnant, let the doctors and radiographers know immediately and you will be offered a pregnancy test. Planning your treatment For most curative (radical) treatments, planning is a very important part of radiotherapy and may take a few visits. Careful planning makes sure that the radiotherapy is as effective as possible. It ensures the radiotherapy rays are aimed precisely at the cancer and cause the least possible damage to the surrounding healthy tissues. The treatment is planned by your clinical oncologist, a psychiatrist, a physicist and sometimes by a radiographer. You may have your first treatment on the same day as your planning session, but usually it is necessary to wait a number of days, sometimes up to two weeks, while the physicist and the oncologist prepare the final details of your treatment. On your first visit to the radiotherapy department, you will have a CT (computerised tomography) scan taken of the area to be treated. A CT scan takes lots of images from different angles to build up a three-dimensional picture of the area. At the same time, therapy radiographers will take measurements from you which are needed for treatment planning. This session will usually take about 45–60 minutes. Sometimes you may also need to go to the hospital’s scanning department to have an MRI scan. This uses powerful magnetic fields to give a detailed picture of part of your body, which can give additional useful information. The radiographer’s measurements and the information from the scans is fed into the radiotherapy – planning computer to help your doctors plan your treatment more precisely. Some special procedures may be necessary to make sure the radiographers get a clear picture. The radiographer will explain these to you. For example, to plan treatment to the pelvic area, a liquid that shows up on x-ray may be passed into your back passage or into your bladder, or a tampon may be used to show the exact position of the vagina. These procedures may be slightly uncomfortable but are not painful and take only a few minutes. They are used only for planning the treatment, and not during the treatment sessions. It is important for you to feel that you are involved in your treatment, so feel free to ask as many questions as you like. For some conditions, like many skin cancers and for palliative radiotherapy, radiotherapy may be planned and given in a very simple way. Your specialist may simply put marks on your skin, with a soft pen, where the treatment is needed. Positioning During the treatment planning you will be lying on a fairly hard couch that can be uncomfortable. If it is, let the radiographer know as you can often be made more comfortable by having foam pads put underneath you. You have to lie very still for a few minutes so that accurate measurements can be taken and your exact position recorded. The radiographer can then make sure that you are lying in the correct position each time you have treatment. Skin markings Once the treatment area has been finalised, ink markings are usually made on your skin to pinpoint the exact place where the radiation is to be directed. The staff will explain how to look after these markings. If the marks begin to rub off, tell your radiographer. Do not try to redraw them yourself. Since they can rub off onto clothing, some people choose to wear older clothes next to the skin during their treatment. Sometimes two, three or more tattoo marks are also made on the skin. These are permanent, but they are the size of a pinpoint and will only be done with your permission. It is a little uncomfortable while it is being done, but is a good way of making sure that treatment is directed accurately. The tattoo marks are also useful once treatment has finished, as they show where the radiotherapy was given and prevent further radiotherapy being given to that area in the future. Mould Room As radiotherapy is planned very precisely, it is important to keep the relevant part of the body as still as possible during treatment so that exactly the right area is treated. For radiotherapy to some parts of the body, a see-through plastic device called a 'mould' or 'shell' may be made, to prevent movement during treatment. This is often used for treatments to the head and neck area. Sometimes a mould of your leg or arm is used to keep the area still during treatment. Marks can be made on the mould instead of your skin. Your mould will be made before your treatment is planned. The mould is made of clear Perspex or a plastic mesh. The Perspex mould is made using a plaster cast, that is first taken of the body part. This involves using strips of wet plaster bandage that are laid across the body. The plaster takes about five minutes to set. Some people may find this claustrophobic or a little frightening, especially if the mould is of the face and neck. After you leave the department, Perspex is moulded onto the cast to form a mask. Some hospitals use a plastic mesh instead. The plastic mesh becomes soft in warm water and can be moulded to your body. It hardens after a few minutes and is then ready to use. Your mould should fit snugly and will be ready to wear at your first planning or treatment session. Moulds covering the face will have holes cut for the eyes, nose and mouth. They may feel claustrophobic for some people, but it can help to remember that you will only have one on for a few minutes at a time. Having your treatment Before your first treatment, the radiographers will explain to you what you will see and hear. It is quite normal to feel anxious about having your treatment, but as you get to know the staff and understand what is going on it should become easier. The sight of large radiotherapy machines can be frightening, especially for children. Don't be afraid to talk about any fears or worries to the staff; they are there to help you, and the more you understand about your treatment the more relaxed you will be. Radiotherapy itself is painless and each session may take anything from a few seconds to several minutes. Because your positioning is so important, the radiographers may take a little while to get you ready (they may call this setting up). The radiographers will position you carefully on the table and adjust the height and position of the table itself. The room may be in semi-darkness while this is happening. Try to relax as much as possible. Once you are in the correct position the staff will need to leave you alone in the room, to prevent them from being exposed to any unnecessary radiation. Don't worry if the staff seem to rush out of the room once they have positioned you, this is just to keep your treatment time as short as possible. Radiotherapy units have many patients to treat and the staff need to keep appointments on time. Some treatment rooms have tape or CD players so that you can listen to music while having your treatment, to help you to relax. During treatment you will be alone for a few minutes but there will often be an intercom so that you can talk to the radiographers. They will be watching you carefully from the next room, either through a window or on a closed-circuit television screen. To protect your privacy, no one else will be able to see you. If you have any problems, you can raise your hand to attract the radiographers attention and they will come in to help you.Most radiotherapy machines will be able to rotate around your body to give the treatment from several different directions. At first, this and the sound of the machine can be unsettling. Positioning the radiotherapy machine The radiographers may have to come into the treatment room to change your position slightly in the middle of your treatment. Also, small changes sometimes have to be made to your treatment plan. There may be various reasons for this. Your specialist and the radiographers can explain any changes to you. General side effects of radiotherapy While radiotherapy can destroy cancer cells, it can also have an effect on some of the surrounding normal cells. The side effects that may occur are described in the following pages. It is important to remember that no person will have more than a few of them, and for many people they may be mild. Years ago, in the 1950s and 60s, radiotherapy often caused very severe side effects, especially skin burns and scarring. There have been huge improvements in the machines that give the treatment, and severe side effects are now very rare. As radiotherapy affects people in different ways, it is difficult to predict exactly how you will react to your treatment. Before you start, the staff will discuss with you any likely side effects of the particular treatment you are having. They can also give tips on how to deal with them and how they can be treated. Being aware of side effects in advance can help you to cope with any problems that occur. Most side effects of radiotherapy disappear gradually once the course of treatment is over. However, for some people, they may continue for a few weeks. Tiredness You may feel very tired during your radiotherapy. This can often be made worse by having to travel to your treatment each day. Listen to your body, and if necessary, allow yourself extra time to rest, perhaps by taking a nap in the afternoons. It may help if you spread chores out over the week, sit down to do them, wherever possible, and accept any offers of help. Tiredness can be a problem for some months after your treatment has finished Eating and drinking As always during treatment of any kind, it is important to maintain a healthy diet and drink plenty of fluids. At times you probably won't feel like eating, or you may find that your eating habits change. It may be easier to have small snacks throughout the day rather than large meals. It is not unusual to lose a little weight during radiotherapy, but if you are having any problems with eating it is important to tell the radiotherapy staff. They can arrange for you to talk to the dietitian at the hospital. Skin care Some people develop a skin reaction while having external radiotherapy. If this effects you, it will normally happen after 3–4 weeks. People with pale skin may find that the skin in the treatment area becomes red and sore or itchy. People with darker skin may find that their skin becomes darker and can have a blue or black tinge. The amount of the reaction depends on the area being treated and the individual's skin. Some people have no skin problems at all. Your radiographers will be looking for these reactions, but you should also let them know as soon as you notice any soreness or change in skin colour. It’s important not to use any creams or dressings unless they have been prescribed or recommended by your specialist or the radiographer. Occasionally, if your skin gets very sore, your treatment may have to be delayed for a short time to allow the area to recover. Staff at the radiotherapy department will be able to give you advice on how to look after your skin in the area being treated. Care of the skin will vary according to the part of the body that is being treated and the dose of radiotherapy that the skin is receiving. You may be advised to use only tepid water and plain soaps, without any perfume, to wash the area; and not to soak too long in the bath. You can dry your skin by patting it gently with a soft towel, but you shouldn’t rub the area as this may make it sore. Perfumed soaps, talcum powder, deodorants and perfumes may also make your skin sore and should not be used. The staff at the hospital may suggest that you gently apply plain moisturisers, such as E45 cream or aqueous cream, to the area. After your treatment, plain soap and plain moisturisers are often recommended. Aloe vera cream can sometimes help the skin to heal. Always check with the radiotherapy staff before applying anything to your skin. It is very important that any marks put on your skin to show the treatment area are not removed. If the marks do fade or disappear, do not try to replace them yourself but let the radiotherapy staff know. Men who are having radiotherapy to the head and neck may be advised not to shave the area, or to use an electric razor rather than wet-shaving. These restrictions apply only to the treatment area, and the rest of your skin can be treated normally. Your skin may peel after the redness has faded, but it will gradually heal. Changes in the skin usually settle down two to four weeks after the treatment has finished, but the area may stay slightly darker than the surrounding skin. Avoiding the sun Your skin in the treated area is very sensitive and needs protecting from the sun or cold winds. If you are having radiotherapy to the head or neck, try wearing a hat or a silk or cotton scarf when you go outside. For at least the first year after your radiotherapy, it is very important to cover the treated area if you go out in strong sunshine. Wear clothing made of cotton or natural fibres, which have a closer weave and offer more protection against the sun. Even after this time, the area of treated skin will be more delicate than normal, so extra care should be taken. Use a sun-cream (of at least factor 15) and cover the area with a hat or close-weave clothing. It is important to remember that you can burn even through clothing if you are out in hot sun for a long time. You can swim as soon as any skin reaction has settled down, usually within a month of finishing treatment. However, if you are swimming out of doors, do not stay in the water too long, and remember to use a waterproof sun-cream. Clothing Loose-fitting clothes, preferably in natural fibres rather than man-made materials, are more comfortable and less irritating to the skin. If you are having radiotherapy to your neck, avoid tight collars and ties. Shoulder straps and bra straps can also cause irritation if they rub against treated skin. If your breast area is being treated, you may be more comfortable not wearing a bra or wearing a cropped top or vest. Smoking Stopping smoking during and after radiotherapy is very worthwhile. Research has shown that it may make the radiotherapy more effective as well as reducing the side effects. It will also improve your general health and reduce your risk of developing other cancers. Stopping smoking or even cutting down at such a stressful time can be very difficult, but do your best. If you want help or advice you can talk to your specialist, GP or a specialist nurse, who will be able to suggest ways of stopping. Send message to doctor to get more information about your treatment. |
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