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What you need to know?

The Spire Oncology Centre offers radiotherapy for cervical, ovarian, vaginal, womb and vulval cancers. At the Oncology Centre we know that cancer treatment can be really daunting and at times confusing: that’s why we have built this website in a simple informative way to help guide you through the process. We’re here to answer any of your questions and aim to ensure your treatment is as seamless and comfortable as it possibly can be. The clinical service is led by a leading clinical oncologist, has some of the latest technologies and a dedicated specialist team. We aim to give you fast access to the treatment you need in a caring, clean and comfortable environment.

Having Radiotherapy treatment

When you first attend the Spire Oncology Centre, a Therapy Radiographer will explain the treatment process and will discuss any possible side effects and their management during and after radiotherapy.

Your first appointment at the centre will be for a CT scan to aid the planning of your radiotherapy treatment.

The Therapy Radiographers will give you some small permanent skin marks called tattoos that allow your position to be replicated for treatment daily.

Following this, your next appointment will be for your first radiotherapy treatment. The subsequent number of treatments will have been defined by your Oncologist as indicated on your appointment list.

You may have been given a gown to wear for your treatment sessions, it is your choice to wear this or not. Please inform the radiographers if you do not wish to wear one.

The Therapy Radiographers will ask you to lie on the couch in the same position you were at the CT planning appointment. They will use your skin marks (tattoos) to accurately align you for treatment. When you are in the correct position, the Therapy Radiographers will inform you that they are leaving the room. You will be asked to remain as still as possible and breathe normally.

The Therapy Radiographers will be observing you on CCTV and can speak to you via an intercom system.

The radiotherapy machine will move around you, it will not touch you and there is nothing to feel or see whilst the radiotherapy treatment is taking place.The average treatment appointment takes approximately 20-30 minutes.

You will be given time to discuss any questions or concerns you may have with the Therapy Radiographers before you start the treatment.

Preparing for treatment

Planning Appointment

Your first appointment at the centre will be for a CT scan to aid the planning of your radiotherapy treatment.

Please arrive at the centre 1 hour prior to your CT scan appointment.

When you arrive at the centre, a Therapy Radiographer will explain to you the procedure required for the preparation needed for the planning CT scan. The Therapy Radiographer will be able to answer any questions and address any concerns you may have. There will be some preparation that is required prior to the scan to ensure a clinically acceptable CT scan is achieved so that your treatment can be effectively planned.

For one week prior to your CT planning scan you will need to do the following to prepare your bowel:

  • Have frequent small meals
  • Try to drink between 1.5-2 litres of non-caffeine drinks daily
  • Take light exercise
  • Visit your GP if you have prior problems with constipation
  • Eat a normal balanced diet but avoid foods that cause excess wind or bloating

Preparation

Every day for treatment, and prior to your CT scan, you will be asked to use a mini enema to empty the rectum. The position of the organs in the pelvis can vary due to stools or gas in the rectum. By having an empty rectum, it helps to ensure a stable reproducible position for treatment each day.

You will also be asked to empty your bladder, then drink a quantity of water and hold your bladder for 30 minutes before your CT scan and before every radiotherapy treatment. By moving the bladder outside of the treatment area the related side effects are reduced.

The bladder also pushes the small bowel away from the radiotherapy treatment area.

Bladder and bowel preparation prior to planning and daily treatment

  1. Insert enema and squeeze contents into your bottom
  2. Return to waiting room and await the feeling to evacuate bowels. This should take around 20-30 minutes.
  3. Empty bowels and bladder
  4. If after waiting 30 minutes for the enema to work, you do not feel the need to pass a bowel motion, go to the toilet and try. Inform the receptionist and a Therapy Radiographer will come and speak to you.
  5. Return to the waiting room and drink the water from the jug (approximately two cups) in a timely manner.
  6. Inform the receptionist you have drunk the water.
  7. The Therapy Radiographer will collect you from the waiting room after 30 minutes.

Skin care during radiotherapy

Radiotherapy may cause a change to your skin in the treatment area. This normally occurs 10-12 days after starting the radiotherapy treatment. Everyone is different in how they react to the radiotherapy treatment.

Skin reactions are not a common side effect when having treatment to the pelvis, but they can happen. Your skin will be monitored daily by your team of radiographers. Some women find that their pubic hair falls out during or shortly after their radiotherapy – this usually grows back after the course of treatment has finished.

Some people find that the ink marks put on the skin during treatment can rub off onto clothing. These should wash off but it may be advisable to wear older clothes during your treatment.

Washing

You are advised to bath or shower as normal during the radiotherapy treatment course. It is fine to wash the area being treated but wash with tepid water as very hot or cold water may irritate your skin.

Use mild unperfumed soap such as Simple or baby soap. The Therapy Radiographers are happy to advise you on suitability of skin care products if you have other preferences. If you wish to have a bath during treatment it is best to avoid bubble bath products as this may irritate your skin.

When drying your skin after washing, it is advised to pat the area dry. We do not recommend using talcum powder in the treatment area.

Clothing

It may be more comfortable to wear loose clothing made of natural fibres around the skin that is being treated.

Sun exposure

Your skin in the treatment area will always be more sensitive to the sun even after the radiotherapy treatment has finished.

It is best to avoid sun exposure to the treatment area whilst you are undergoing radiotherapy. Please do not put any sun protection creams on your skin whilst having treatment.

After you have finished your course of radiotherapy and any skin reaction has settled it is recommended to cover the area of treatment that may be exposed to the sun or use a sun block with SFP 50. 

It is important to do this for at least six months after completing radiotherapy.

Short term side effects

Radiotherapy side effects can depend on how each individual reacts to the treatment and any side effects normally start to become noticeable approximately half way through your course of treatment.

Cystitis

Radiotherapy treatment can cause the lining of the bladder to become irritated. This can result in the feeling of needing to pass urine more frequently during the day and at night. You may experience pain; this can be due to the inflammation caused or by a possible infection so please advise your Therapy Radiographer if you are experiencing any of these symptoms.

Increasing your fluid intake, in particular barley water and cranberry juice can relieve the symptoms of cystitis. Patients on Warfarin should speak with the Therapy Radiographers as they will need to limit the amount of cranberry juice consumed due to possible interactions with the Warfarin medication. Try to avoid too many caffeinated drinks or alcohol throughout the day to avoid irritation to your bladder.

Diarrhoea

Radiotherapy can affect your bowels bymaking them work faster. This can lead to you requiring opening your bowels more frequently. Sometimes this can progress to diarrhoea like symptoms, where motions may become loose and with a sense of urgency. It is advised to tell the Therapy Radiographers looking after you if you get an onset of loose motions. They will be able to advise you about the possible change to your diet or medication to help manage these symptoms. It is important to drink plenty of fluids to help replace the fluids lost by opening your bowels frequently. Occasionally you may pass some blood in your stools, again please let the Therapy Radiographers know if this is a symptom you experience.

Haemorrhoids (piles)

For those that have pre-existing problems with haemorrhoids or piles, radiotherapy may aggravate this and cause them to flare up. Do not use any existing medicated cream until you have been advised by the Therapy Radiographer as some creams may interfere with the radiotherapy and cause irritation. Others find that the radiotherapy may cause some soreness inside the back passage, which can make it sore or uncomfortable to open your bowels. Please mention to the Therapy Radiographers if any of these symptoms occur.

Sexual changes

It is natural to be anxious about resuming intercourse if you are sexually active. Many women feel the same and you are not alone. Sexual intercourse after radiotherapy is perfectly safe. 

It will not make the cancer return and you cannot pass on cancer to your partner. However, radiotherapy can make the vagina more sensitive, tender and possibly a bit dry. 

We suggest the use of a lubricant. You may find that once you have finished treatment it could take about four weeks before it feels comfortable to resume sexual intercourse.

Initially intercourse can be uncomfortable and it is possible that you may notice some spots of blood afterwards. This is normal and nothing to be concerned about. Any prolonged or heavy bleeding should be reported to your doctor.

After radiotherapy you may not have much energy or desire for sex. If these problems continue for months after treatment, please discuss this with your doctor at your follow up appointments,as we would like to help you get back to your normal lifestyle.

 

Long term side effects

Some people find that the side effects from the radiotherapy subside quite quickly after the treatment course has finished. For most this occurs from 3-6 weeks after radiotherapy. However, for some people the side effects can become longer term occurring months or years after the radiotherapy has finished.

Fertility

Some types of radiotherapy treatments to the pelvic area in women can have an effect on fertility. This is unfortunately permanent and will result in early menopause. You can discuss the treatment and management of the menopause with your doctor as this can affect women differently.

In younger women who are still having periods, radiotherapy to the pelvis can affect the ovaries, as they are very sensitive to radiation. You may have two or three periods following radiotherapy but unfortunately this type of treatment can cause you to go in to the menopause early. If you or your partner wishes to discuss fertility further, please talk to
your doctor.

Bowel long term effects

You may be left with an increase in daily bowel movements; this can be as a result of the radiotherapy. Occasionally people notice some blood or mucus when they open their bowels – please inform your doctor if this does occur. It is rare, but sometimes radiotherapy can cause permanent damage to the bowel which may require further investigation and necessary treatment, depending on the level of persistent bowel problem. Your doctor will discuss this in more detail when they explain about the radiotherapy treatment.

Bladder long term effects

The radiotherapy may sometimes affect the lining of the bladder. This may result in your bladder holding less urine and you may need to empty your bladder more frequently therefore changing your urinary habits. Rarely, some patients can have blood in their urine as a result of long term changes to the lining of the bladder.

Pelvic bone

Radiotherapy can weaken bone within the treated area. Stress fractures are rare but can happen months after you’ve completed your treatment. Your doctor can check for this by an MRI scan, however, management is usually no more than pain killers, anti-inflammatory medications and rest.

Other considerations during your radiotherapy treatment

Fatigue

Some people can experience tiredness during their course of radiotherapy. Some people manage to continue working whilst they are having radiotherapy whilst others find that they are too tired. It is best to listen to your body and do as much as you feel capable, resting
when necessary.

Light exercise can help with energy levels. It is advised to drink plenty of fluids as this can help combat tiredness – two litres (3-4 pints) is recommended for your daily intake, try to consume caffeinated drinks in moderation as these can dehydrate you. Your Radiotherapy team will be able to advise you of ways to help manage tiredness if this becomes an issue for you.

Eating well

It is recommended that you follow a balanced healthy diet during treatment. We will advise you if you need to change your diet during radiotherapy. Drinking plenty of fluids is also advised.

Swimming

If you wish to swim whilst having radiotherapy treatment, you can swim in any type of water but it is important to carefully wash and moisturise the area afterwards. If you find swimming irritates your skin you may need to stop whilst you’re having treatment. The Therapy Radiographers will advise you if it is best to avoid swimming all together.

Emotional effects

A cancer diagnosis can bring with it many feelings of fear, anxiety, low mood and depression.

We understand that going through diagnosis and cancer treatment can be both difficult for you and your friends and family. At the centre we are here to provide a supportive environment. Please talk to the Therapy Radiographers if you feel you need any additional support.