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What do you need to know?

Here are details about the planning and treatment process and will advise regarding possible treatment related side effects. It is important to remember that the effects of radiotherapy vary from person to person, and depend on the dose of radiotherapy received, the length of treatment time and the area beingtreated

Having radiotherapy treatment

When you first attend the Spire Specialist Care Centre, a therapy radiographer will explain the treatment process. They will also discuss any possible side effects and their management, during and after radiotherapy. Your first appointment at the centre will be for planning purposes. A reproducible treatment position will be decided upon; if you are receiving treatment to your upper oesophagus it may be necessary
to first make an immobilisation shell.


Once you are in a stable position you will have a CT scan, the purpose of which is to plan your radiotherapy treatment. The therapy radiographers will need to make some marks on your skin to ensure that your position is replicated for daily treatment. If you are having your thorax or abdomen treated, small permanent freckle-like skin marks called tattoos will be made with your permission. If a shell has been made the marks will be placed on the shell with pen and not on your skin.

The immobilisation shell (mask)

The purpose of the immobilisation shell is to ensure your position is accurately replicated for treatment each day. The mask is made with you lying in the treatment position (usually on your back, with your arms by your side). A support is placed under your head that tilts your head to the correct position.

A plastic mesh material will be warmed and softened in water until it is flexible. The radiographers will place this mesh over your face and head, gently moulding it around you. You will need to lie still for a few minutes until it has set before being lifted off. You will be able to breathe normally and will be able to hear the radiographers throughout the procedure who will be with you the whole time.

The mask should be a snug fit to ensure that your position is accurate and
reproducible on a daily basis.

Treatment

The therapy radiographers will ask you to lie on the couch using the same
immobilisation equipment and in the same position you were in for your CT planning appointment. Using either your tattoos or the marks on the shell, the radiographers will 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 radiographers will be watching you from outside of the room on a video link and can speak to you via an intercom system. X-ray Images will be taken prior to delivering any treatment to ensure that you are in the correct position and any adjustments to your position will be made if necessary.


Treatment is painless; the radiotherapy machine will move around you but will not touch you. You cannot see or feel the treatment taking place but you will hear a buzzing sound from the machine which is normal.

Side effects

To help ensure that you are receiving side effect information most specific to you, below highlights the most relevant side effects to each treatment site. If you are still unsure or have any further questions once you have finished reading this leaflet, please speak with the therapy radiographers who will be able to advise you on what to expect.

Upper Oesophagus

Short-term side effects

Skin

Within the treatment area your skin may become irritated. Whilst skin reactions are not always a common side effect when receiving radiotherapy to the abdomen or thorax, a reaction can sometimes be more pronounced on your back. This can mean that by the end of treatment there is an area of defined redness (much like mild sunburn) and it may be dry and irritated. This can start to occur 10-12 days after
starting the radiotherapy treatment. 

Your skin will be monitored daily by your team of radiographers and recommended creams and advice will be given to you when appropriate.

Oesophagitis and difficulty swallowing (dysphagia)

Whilst having treatment the lining of your oesophagus may become
inflamed. You may experience a loss of appetite, indigestion/heartburn,
difficulty swallowing, possible bloating and belching. These are all common side effects of radiotherapy. Towards the end of your treatment it can be common for your throat/oesophagus to be sore. Your doctor can prescribe medications to help and you will be reviewed weekly by the review Radiographer. As a result of these side effects you may find it increasingly
difficult to eat the foods that you are used to and a dietician will see you
regularly to offer advice on how you can help maintain a nourishing diet.

Hoarse voice

You may also experience hoarseness (a gruff sounding voice), particularly if the treatment area includes the upper end of your oesophagus. Again, this is a normal reaction and is caused by the radiotherapy causing inflammation of the vocal cords or oesophagitis.

Fatigue

Fatigue is a very common side effect of radiotherapy treatment. Tiredness and fatigue usually occurs towards the end of treatment and is a normal reaction. The fatigue may even continue for several weeks after your radiotherapy has finished. Do not worry, this is a normal
reaction. It is usually a combination of travelling to and from hospital, the side effects of the treatment, coping with a diagnosis of Cancer, and continuing with normal life.


Long-term side effects

Dysphagia

As a result of treatment the oesophagus can become narrower making it harder to swallow some foods. It may be necessary to modify your diet and in some situations the oesophagus may need to be widened by putting a stent in place. You will be monitored by your doctor once treatment has finished and if you experience any of these symptoms please contact them.

Radiation Pneumonitis (inflammation of lung tissue)

In some cases (depending on the location of the area to be treated) there may be a slight increased risk of radiation pneumonitis. This condition is an inflammation of lung tissue which can result in shortness of breath and a dry cough. The doctor will plan your treatment to reduce this risk as much as possible and if you have any concerns please talk to a member of staff or ask to speak with your doctor.

Pain on swallowing

You may find that taking soluble painkillers before mealtimes can help you chew and swallow more easily. It is important to take painkillers regularly to maximise their benefit but to never exceed the recommended dosage, please ask the Radiographers about this.

It may also be necessary to change your diet if you are experiencing pain when swallowing. A softer diet, avoiding hot and spicy foods and eating smaller amounts more regularly may be easier to cope with. Try eating foods with sauces and gravies and avoid rough-textured food like
toast, crisps or raw vegetables as they can irritate your oesophagus if it is sore. Keep eating your favourite foods where possible, but make changes to soften them. For example, finely chop meat and vegetables
then casserole or stew them; and cut the crusts off bread for softer sandwiches. If you have a blender you could liquidise cooked foods.

It is advisable to increase your fluid intake while having radiotherapy treatment. Carrying a bottle of water with you at all times and having sips throughout the day will help with this. Alcoholic spirits should
be avoided as they are an irritant.

In addition to this you will also be referred to a dietician who will monitor your diet and weight over the course of your treatment and be able to provide you with support and advice.

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.

You are advised to drink plenty of fluids, (i.e. water, juice), about eight glasses per day, and to rest whenever the need arises. You are encouraged to maintain a lifestyle that is normal for you. Light exercise can help with energy levels. 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.

Mid oesophagus

Short-term side effects

Skin

Within the treatment area your skin may become irritated. Whilst skin reactions are not always a common side effect when receiving radiotherapy to the abdomen or thorax, a reaction can sometimes be more pronounced on your back. This can mean that by the end of treatment there is an area of defined redness (much like mild sunburn) and it may be dry and irritated. This can start to occur 10-12 days after
starting the radiotherapy treatment. 

Your skin will be monitored daily by your team of radiographers and recommended creams and advice will be given to you when appropriate.

Oesophagitis and difficulty swallowing (dysphagia)

Whilst having treatment the lining of your oesophagus may become
inflamed. You may experience a loss of appetite, indigestion/heartburn,
difficulty swallowing, possible bloating and belching. These are all common side effects of radiotherapy. Towards the end of your treatment it can be common for your throat/oesophagus to be sore. Your doctor can prescribe medications to help and you will be reviewed weekly by the review Radiographer. As a result of these side effects you may find it increasingly
difficult to eat the foods that you are used to and a dietician will see you
regularly to offer advice on how you can help maintain a nourishing diet.

Fatigue

Fatigue is a very common side effect of radiotherapy treatment. Tiredness and fatigue usually occurs towards the end of treatment and is a normal reaction. The fatigue may even continue for several weeks after your radiotherapy has finished. Do not worry, this is a normal
reaction. It is usually a combination of travelling to and from hospital, the side effects of the treatment, coping with a diagnosis of Cancer, and continuing with normal life.

Hair loss

There may be a temporary loss of chest hair (in male patients) in the area treated. This is a normal reaction. It may take a few months to regrow or the hair loss maybe permanent depending on our individual treatment plan. Your consultant will discuss this with you prior to starting radiotherapy treatment.


Long-term side effects

Dysphagia

As a result of treatment the oesophagus can become narrower making it harder to swallow some foods. It may be necessary to modify your diet and in some situations the oesophagus may need to be widened by putting a stent in place. You will be monitored by your doctor once treatment has finished and if you experience any of these symptoms please contact them.

Radiation Pneumonitis (inflammation of lung tissue)

In some cases (depending on the location of the area to be treated) there may be a slight increased risk of radiation pneumonitis. This condition is an inflammation of lung tissue which can result in shortness of breath and a dry cough. The doctor will plan your treatment to reduce this risk as much as possible and if you have any concerns please talk to a member of staff or ask to speak with your doctor.

Pain on swallowing

You may find that taking soluble painkillers before mealtimes can help you chew and swallow more easily. It is important to take painkillers regularly to maximise their benefit but to never exceed the recommended dosage, please ask the Radiographers about this.

It may also be necessary to change your diet if you are experiencing pain when swallowing. A softer diet, avoiding hot and spicy foods and eating smaller amounts more regularly may be easier to cope with. Try eating foods with sauces and gravies and avoid rough-textured food like
toast, crisps or raw vegetables as they can irritate your oesophagus if it is sore. Keep eating your favourite foods where possible, but make changes to soften them. For example, finely chop meat and vegetables
then casserole or stew them; and cut the crusts off bread for softer sandwiches. If you have a blender you could liquidise cooked foods.

It is advisable to increase your fluid intake while having radiotherapy treatment. Carrying a bottle of water with you at all times and having sips throughout the day will help with this. Alcoholic spirits should
be avoided as they are an irritant.

In addition to this you will also be referred to a dietician who will monitor your diet and weight over the course of your treatment and be able to provide you with support and advice.

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.

You are advised to drink plenty of fluids, (i.e. water, juice), about eight glasses per day, and to rest whenever the need arises. You are encouraged to maintain a lifestyle that is normal for you. Light exercise can help with energy levels. 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.

Lower Oesophagus/ stomach/pancreas

Short-term side effects

Skin

Within the treatment area your skin may become irritated. Whilst skin reactions are not always a common side effect when receiving radiotherapy to the abdomen or thorax, a reaction can sometimes be more pronounced on your back. This can mean that by the end of treatment there is an area of defined redness (much like mild sunburn) and it may be dry and irritated. This can start to occur 10-12 days after
starting the radiotherapy treatment. 

Your skin will be monitored daily by your team of radiographers and recommended creams and advice will be given to you when appropriate.

Oesophagitis and difficulty swallowing (dysphagia)

Whilst having treatment the lining of your oesophagus may become
inflamed. You may experience a loss of appetite, indigestion/heartburn,
difficulty swallowing, possible bloating and belching. These are all common side effects of radiotherapy. Towards the end of your treatment it can be common for your throat/oesophagus to be sore. Your doctor can prescribe medications to help and you will be reviewed weekly by the review Radiographer. As a result of these side effects you may find it increasingly
difficult to eat the foods that you are used to and a dietician will see you
regularly to offer advice on how you can help maintain a nourishing diet.

Nausea

If the treatment area is close to your stomach it is possible that you may feel sick and possibly be sick. Please inform the radiographers if this happens. The doctor can prescribe anti-sickness tablets to help alleviate this. 

Diarrhoea

Treatment areas close to the stomach may result in you experiencing increased frequency when opening your bowels, sometimes leading to diarrhoea like symptoms. Please inform the Radiographers of this and they will be able to advise you of any dietary changes that might be helpful or appropriate medication.

Fatigue

Fatigue is a very common side effect of radiotherapy treatment. Tiredness and fatigue usually occurs towards the end of treatment and is a normal reaction. The fatigue may even continue for several weeks after your radiotherapy has finished. Do not worry, this is a normal
reaction. It is usually a combination of travelling to and from hospital, the side effects of the treatment, coping with a diagnosis of Cancer, and continuing with normal life.


Long-term side effects

Dysphagia

As a result of treatment the oesophagus can become narrower making it harder to swallow some foods. It may be necessary to modify your diet and in some situations the oesophagus may need to be widened by putting a stent in place. You will be monitored by your doctor once treatment has finished and if you experience any of these symptoms please contact them.

Nausea and Appetite

During your radiotherapy treatment you are advised to maintain a healthy well balanced diet, as much as possible. Nausea can often mean a reduced appetite. Eating foods containing ginger, trying crystallised
ginger or drinking fizzy ginger beer can sometimes help to alleviate this. Sipping a fizzy drink is a popular remedy for feeling sick. In addition to ginger beer you can also try mineral water, lemonade or soda water, and sip it slowly through a straw.

If you are still suffering from nausea that is uncontrolled then please speak to the Radiographers and anti-sickness tablets can be prescribed or reviewed.