Radiotherapy
- A guide for patients and their families
Radiotherapy - A guide for patients - booklet coverContents
Introduction
This booklet is to tell you about radiotherapy. The Christie is a specialised centre for radiotherapy, and
patients come for treatments that are not available at
general hospitals. If you are having radiotherapy as an
inpatient, please bring this booklet with you.
This is a general introduction to radiotherapy. If you would
like more detailed information about your own treatment,
please ask the staff .
You may have heard about radiotherapy from people you
know, or from the patients in the hospital. Their information
may not apply to you.
Some other Christie information booklets are listed here.
What
is Radiotherapy?
Radiotherapy is the use of exact,
carefully measured doses of
radiation to treat diseases. It is used
to treat a wide variety of conditions
including cancer, thyroid disorders
and some blood disorders.
Most patients having radiotherapy
are treated using a high energy
beam of x-rays delivered to the
precise area, by a machine called a
linear accelerator. The rays are used
only to treat the tumour and a small surrounding area.
While not all machines look alike, they all work in a similar
way. In fact, these machines are just more powerful
versions of the x-ray machines that are used to take
pictures of the chest, broken bones and so on.
Radiotherapy is often given in several small doses over
a specified period of days or weeks, but may be given
in a single treatment. This should not be confused with
chemotherapy which uses drugs to treat cancer. In some
situations, your doctor will recommend both radiotherapy
and chemotherapy.
Specially trained male and female health care professionals
called therapy radiographers operate the radiotherapy
machines. They will be able to answer any questions or
concerns you may have.
Your
first visit to the department
The specialist doctor who will look after you is a clinical
oncologist. He or she will examine you and may arrange
for tests such as x-rays, scans and blood tests. These are
to check your general health, and to help decide on the
details of your treatment.
A team of doctors – consultants, registrars and senior
house officers - will care for you. This team will not
necessarily include the doctor who saw you first of all,
but one particular consultant will be responsible for your
treatment.
In choosing your treatment, your clinical oncologist at The
Christie has carefully considered the nature of your illness,
and your particular needs. Once treatment has been agreed
with your doctor, we will send you an appointment for
treatment preparation.
The preparation for treatment takes some time - in some cases
it may take up to 2 weeks or more. It is time well spent, as
the treatment is being tailored to your particular needs.
Agreeing to treatment
Consent
to treatment
The doctors, clinic nurses and specialist radiographers
will normally give you some written information to
support what they have said about your treatment. At
the time your treatment is being planned, you will have
a further opportunity to discuss anything that you do not
understand, or any anxieties you may have, before you
actually start.
We will ask you to sign a consent form agreeing to accept
the treatment that you are being offered. The basis of
the agreement is that you have had The Christie’s written
description of the proposed treatment, and that you have
been given an opportunity to discuss any concerns.
Radiation can be harmful to the unborn child. It is
important to let the radiographers know if you have missed
a period, or suspect that you might be pregnant before you
are exposed to any radiation.
How does radiotherapy work?
Our bodies are made up of cells and all cells are able to
divide. If radiation hits a cell that is dividing it will be
damaged. Cancer cells are much less able than normal
cells to repair the damage, so more of the cancer cells will
be destroyed.
What are the benefits of this treatment?
Radiotherapy works by damaging cancer cells while causing
as little damage as possible to normal cells. The benefits of
treatment vary from one person to another depending on
the sort of illness. The aims of treatment may include an
attempt to:
- cure the cancer
- Or reduce the chances of the cancer coming back, such
as after surgery
- Or shrink the tumour so that surgery is easier to perform
- Or shrink the tumour which may slow down its progress
and give relief from troublesome symptoms
Are there any alternatives to this treatment?
The doctor at your local hospital may have advised you
about any other possible treatments before referring you
to The Christie. Your Christie consultant will be happy to
discuss any concerns you may still have.
What will happen if I do not have this treatment?
There is a risk that your cancer may continue to grow and
your symptoms may get worse. You can discuss what to do
next with your doctor.
Treatment
preparation
Treatment preparation may be done on a special x-ray
machine called a simulator (see right) or on a C.T.
Scanner. Usually marks will be drawn
onto your skin using a special skin pen. The
marks may rub off a little onto clothing. Do not
worry too much if they do - they will wash out -
but it might be sensible to wear older clothing.
The radiographers will explain how you can keep
the treated area clean, and will tell you when
you can wash the marks off. During
the preparation stage the marks may
be visible if you are having your head,
neck or chest treated, so you may want
to bring a scarf with you. The pen
marks will gradually fade away.
Tiny
permanent marks will also be made on
the skin, which are essential to aid the
accurate setup of your treatment.
Mould
preparation
It is sometimes necessary to make a plastic mould to fit the
treated area such as the head, neck or limb. The mould
helps us to ensure that the treatment is delivered accurately
each day. Treatment marks are put on the mould, so it
is not normally necessary to put marks on your skin. As
part of the preparation for the mould, you may need to
attend the hospital several times before your treatment can
start.
The number of visits depends on the type of mould
you are having. Different types of mould are used for
various treatments. The Mould Room staff will explain the
procedure when you come for your first visit.
Your
treatment
On the day of your first treatment, you will come to the
Radiotherapy department. If you are an inpatient, a male
or female radiotherapy care assistant may collect you from
your ward and escort you to the department.
You may have already visited this
department as part of the preparation for
treatment, and met some of the therapy
radiographers. They are easy to recognise
in their white uniforms with maroon
trim or maroon tunic. The radiographers
will be giving you the precise treatment
prescribed by the doctor. They will
explain to you what is going to happen
before they take you into the treatment room. The Christie
is a training hospital so you may meet male and female
students in the Radiotherapy Department who may be
involved in the delivery of your treatment.
We will ask you to remove or loosen any clothing that
covers the area being treated. There are cubicles for
changing and loose gowns to wear, if necessary. The
radiographer will help you onto the treatment bed and
will then adjust both the bed and the machine to the
exact positions that are needed. They will try to make you
comfortable as you will be asked to keep as still as possible
for a few minutes during treatment.
The radiotherapy machines are quite big, and if you have
never seen them before, you might feel anxious. But there
is no need to worry - the treatment is absolutely painless. It
is just like having an x-ray picture taken. The treatment only
lasts a few minutes. However, the treatment session may
take about 15 minutes, allowing time for changing and the
machine to be set up.
The radiographers operate the
machines from outside the room.
When you are in the correct
position, they will leave the room
while you have your treatment.
This is the only time you will
be alone, but even then, the
radiographers will be watching
you carefully on a closed circuit
television system (see picture). If
for any reason you need them,
just wave your hand and they will
interrupt the treatment and come in
to you immediately.
Some people are worried that they
will be completely enclosed by the
machine - this will not happen.
The overhead section of the
machine can rotate, but nothing
will touch you. Most machines
make a buzzing noise when they are
operating. This is how you will know
when the treatment is happening.
After a few minutes, your treatment
will be over for that day. This
routine will go on each working
day until your course of treatment
is finished. The prescribed
radiation dose and the number of days over which it is
given varies between patients. We will tell you before the
start of treatment how many treatments you will need.
Normally, there is no radiotherapy treatment on Saturdays
and Sundays, and this is taken into account when your
treatment is planned.
The radiographer will give you information about who to
contact if you have any problems during treatment.
Your treatment appointment time may vary from day to
day for a variety of reasons. Please discuss this with the
radiotherapy support workers on your treatment unit.
They help patients plan their appointments for treatment
and, when asked, can usually find a solution to any small
problem that can arise. We try and avoid unplanned gaps
in your treatment because if you miss a session it reduces
the effectiveness of your treatment.
Some
questions about treatments
Will it hurt?
No. You will feel no pain at all while you are
actually having your treatment.
Will I lose my hair?
Not unless your head is being treated. You
may lose body hair in the area being treated and this hair
loss can sometimes begin during and after treatment.
But it usually starts to grow back some time after
treatment is finished. Wigs are available through the
hospital, if needed. Loss of hair happens more often with
chemotherapy, and even then, it does grow back.
Is it safe?
Radiation used in medical treatment is given in controlled,
carefully measured doses. The aim is to treat the illness
whilst minimising the dose to the surrounding tissues.
Will I be radio-active?
No. Patients treated by x-rays do not become radio-active.
The radiation does not stay in your body after treatment, so
you cannot do anyone else any harm. It is perfectly safe for
I was
surprised
how quick
and painless
it was
you to mix with other people and to have visitors if you are
on the wards.
I already have problems with my health. Will radiotherapy
treatment make them worse?
Not usually, the treatment may make you feel more tired
than normal. Please tell your treating team about any
existing medical conditions. Ask your Christie doctor if you
are worried about any other health problems.
If I have to stay in hospital, can I go home for the weekend?
Yes, if your doctor thinks that you are well enough. You
must make your own transport arrangements to go
home and come back to hospital. The time of weekend
leave varies, so please check with the nurse in charge of the
ward and the therapy radiographers treating you about the
time you need to return.
As an inpatient, when will I have my treatment?
The radiographers will give you a leaflet on your first
appointment at the Radiotherapy department, explaining
how many treatments you will have and the date of your
last treatment. The treating team will call for you when
they have a free slot. If you are going on weekend leave,
please let the staff know and they will do their best to treat
you as early as possible.
On most wards, you will be able to wear your own clothes and
can go out, once you have had your treatment for the day.
Check with the nurse in charge before you leave the ward.
Can I be treated as an outpatient?
Yes, if your doctor thinks you are well enough. Some
people continue to work, but you may find it difficult to
go out to work, run the home and cope with treatment as
well. After daily travel and treatment, you may
feel tired and need to rest. Space in the waiting
area is limited, so please try to bring only one
person with you.
If you are having treatment as an outpatient,
the radiographers will give you an appointment time for
the first treatment when you attend for your planning
session. After that, you can tell your treating team the time
that you prefer and they will try and arrange a convenient
appointment time. Please try and be as flexible as possible
and give priority to your treatment sessions over other
general appointments.
You may be entitled to help with travel costs. Ask at the
Post Office or local DSS for leaflet HC1 ‘Help with health
costs’. Other financial help may be available through The
Christie Social Work department.
What happens if I need transport to and from the
hospital?
Please tell your Christie doctor as soon as possible so this
can be arranged. Hospital transport is arranged as a block
booking for all your treatments. You may be kept waiting
for some time either side of your appointment because
of the high demand for transport. Please take this into
If you are being treated as an outpatient, you
will have to pay for your prescriptions unless
you are exempt. If you think you will need more
than 5 items in the next 4 months, you will find it
cheaper to buy a pre-payment certificate. Ask for
details at The Christie Pharmacy.
*The government has announced that free prescriptions for cancer
patients will be introduced some time in 2009.
Side-effects
From treatment
Side effects from radiotherapy vary. Some people have
hardly any side effects. Any side effects you get will
depend on which part of your body is treated, and on the
number of treatments you have. Even people who have
had very similar treatments can have different side effects.
Most people notice the side effects during the second half
of their course of treatment. These may well continue after
you have finished your treatment, but they should gradually
fade by 4 to 6 weeks after treatment.
During your course of radiotherapy, one of the doctors,
nurses or radiographers on the team looking after you will
see you regularly.
Sore skin:
The skin is likely to become red and itchy in the treatment
area and sometimes sore. This will depend partly on
the type of machine that you are treated on. Ask the
radiographers for advice, as it is easier to minimise any
reaction if we look after the skin early on.
Nausea:
This also depends on which part of the body has been
treated. If you do experience sickness please tell the
radiographers - you may be prescribed medication.
Tiredness:
You may feel a sense of fatigue or have less energy during
and after your course of treatment, just as you would
when recovering from an operation. You can help yourself
by taking time to rest and relax before you get tired. Do
not be afraid of asking family and friends for help. Some
patients find that it helps to have a short rest each day
after having their treatment. However, it is beneficial
to take gentle exercise as well as taking rest. There is a
Christie booklet and DVD demonstrating a simple exercise
programme, please ask staff for a copy.
Difficulty with swallowing:
Radiotherapy to the head and neck area or upper chest
can cause a temporary difficulty with swallowing. Tell your
radiographer if you are having problems - you may need
medicine to help with this. The booklet 'Eating:
Help Yourself’
has useful advice on eating when swallowing is difficult.
Stiffness of joints and muscles:
Radiotherapy can cause tightness of muscles and stiff ness of joints.
There may also be swelling and discomfort in the treated area during
and immediately after your course of treatment. If you are concerned
about any of these problems, please contact the Physiotherapy department
on
The Physiotherapy department run exercise classes for patients having
radiotherapy to the breast area. There are relaxation classes held
twice a week open to all patients and carers. For details phone
Late or permanent reactions
It is possible for some types of reaction to occur months
or years after the treatment has finished, although this is
less common these days because of recent improvements
in treatment. Your doctor at the Christie will discuss any
possible late effects with you, and give you further written
information about them if they are at all likely to occur.
Other side effects may appear, depending on the part of
the body that has been treated. The radiographers will
tell you what to expect. If you have any queries after
your treatment, before your follow-up appointment
you can ring the Radiotherapy department on 0161-446
3485 and ask to speak to a radiographer.
What
can the staff do to help?
It is part of the staff’s job to help you through any side
effects you may have. If you feel uncomfortable in any
way, do mention it to the doctor, the nurses or the
radiographers. They all want you to be as comfortable as
possible.
The side effects, including pain, can worsen as treatment
progresses. It is important to tell staff who will be able to
prescribe pain relief which should ease your discomfort.
Speak to the staff if you have any problems or concerns -
however trivial these may seem.
What
can you do to help?
- Wash the treated skin gently with warm water, and pat
dry with a soft towel.
- Do not use any creams, moisturisers, make-up,
deodorants, perfumed soap or talcum powder on the
part of your skin which is being treated. Men should
not use pre-electric or aftershave, if they are having
treatment to the face or neck. Johnson’s baby products
and Simple soap are safe to use. Keep on using
unperfumed toiletries whilst your skin is sore.
- Wear something loose and comfortable. Cotton is
best next to the treated skin - better than man-made
material.
- Men who are having part of their head, face or neck
treated should use an electric shaver. Please remember
to bring one with you if you are an inpatient.
- Keep the area of skin that has been treated away from
direct heat, such as sunlamps, hair-dryers and direct
sunlight. You should take extra care of your skin during
treatment and as long as the reaction lasts. The skin
in the treated area may always be more sensitive, so
you will need to take care in the sun, even after your
treatment has finished. You can use high protection
sun-cream on the treated area when the side effects
have settled.
- Drink plenty of fluids - for example, water, cool drinks,
milk. Take nourishing fluids such as Complan or
Build-up, if your appetite is poor. Some special meal
replacement drinks are available on prescription - ask
the dietitian or your GP for more information.
- Eating difficulties - for more information about nutrition
ask for a copy of ‘Eating: Help Yourself’.
For more information ....
You may have particular queries that are not answered here. Please do not hesitate
to ask the staff.
Relatives and carers
Please share this booklet with your family and friends. It
is important that they feel well-informed and understand
what is happening. Families and carers can have a role in
helping you. There are also videos on radiotherapy which
you can take home to watch. Please ask your doctor, a
radiographer or the ward staff.
Inpatients should be able to go home as soon as their
course of treatment is finished, or very shortly afterwards.
The Community Link Team will arrange for a district nurse
to visit you at home, if this is necessary.
After
care
After you have finished your treatment, you will be told the
arrangements for your first follow-up visit to an outpatient
clinic. This visit is for the clinical oncologist to see how the
treatment is working and how any side effects are settling
down. Most patients continue to be followed up at an
outpatient clinic for several years.
Some people return to The Christie for their follow-up
visits. Other people return to a hospital near their home,
where they will usually see a visiting Christie doctor. It may
be possible to choose the arrangement that suits you andyour family.
If you have any problems before you are due for your first
visit back to the hospital, ask your GP for advice. If you
were an inpatient you could also ring up your ward at
The Christie and speak to a senior nurse. If you have any
problems after your first outpatient visit, contact your GP
straight away rather than wait for your next appointment.
Your doctor may want to arrange an earlier one.
Appointments
Once you are having treatment, if you have a problems with
your appointment time, please contact the Radiotherapy
Department at the Christie on 0161 446 3485 as soon as
possible. It is helpful if you can quote your hospital number
- it will be on your appointment card or letter.
If your follow-up appointment is inconvenient, please contact the Health Records department on 0161-446 3346 /
3347. Or you could write to:
The Health Records Officer,
The Christie NHS Foundation Trust,
Withington,
Manchester M20
4BX.
If you do write, please make sure that your letter arrives
well in advance of your appointment, as this will make it
easier to arrange another one for you.
If you change your address, please let the Health Records
Department staff know your new address - and the address
of your new family doctor.
Other
information
Macmillan Cancer Support
This is a national cancer information charity which runs
a cancer information service. The cancer support service
freephone number is 0808 800 1234. Calls are answered
by specially trained cancer nurses who can give you
information on all aspects of cancer and its treatment.
They also publish booklets which are free to patients, their
families and carers. You can get a copy by ringing the
freephone number. the information is on their website:
www.macmillan.org.uk
Booklets include:
- Specific cancers, for example, Bladder, Cervix, Lung and
Prostate.
- Cancer treatments - such as Understanding radiotherapy and
Understanding chemotherapy.
- Booklets on living with cancer - some of these are listed
below:
- Who can ever understand? - talking about your cancer
- Lost for words: how to talk to someone with cancer
- What do I tell the children?
- Coping with hair loss
- Cancer and Complementary therapies
- Travel and cancer
The Cancer Information
Centre on the glass link corridor has
the full range of Cancerbackup booklets available free to
patients and their relatives/carers.
Please note:
mobile phones can interfere with the treatment equipment. Please look
out for signs letting you know if it is safe to use your mobile phone.
If you do have one with you, you may need to turn it off.
The Christie information
The Christie produces a range of patient information
booklets and videos, some of these are listed below:
- DVDs/Videos: ‘Radiotherapy to the head and neck’ and
‘Radiotherapy: a guide’ - DVDs/Videos can be borrowed to watch at home. Ask
the staff on the ward, in outpatients or in Radiotherapy.
Available in English, Urdu, Cantonese and Mandarin
- Where
to get help: services for people with cancer - This discusses sources of help when you have cancer,
where to go for financial help, palliative care and cancer
support groups.
- Eating:
Help Yourself - This gives advice on eating problems when you don’t
feel well and you are having treatment. Other booklets
give helpful advice on diet: Advice about soft and
liquidised foods and Nutritional Drinks. Please ask staff for a copy.
More detailed information on treatment and side effects is available
for:
Radiotherapy and chemotherapy booklets are available in
There are audio-cassettes on radiotherapy and chemotherapy in
Urdu, Punjabi, Mandarin and Cantonese. Please ask the staff for
a copy or at the Cancer
Information Centre.
Booklets are free to patients coming to the Christie. If you would
like a copy, please ask the ward staff. If you are an outpatient please
ask your nurse, doctor or radiographer.
Large print versions are available, please contact Patient Information
on
Patients, relatives and carers are welcome to visit the Cancer
Information Centre on the glass link corridor for booklets and
information.
How to find the Radiotherapy Department
The Christie Patient Information Service - October 2008 - Review October 2011
CHR/XRT/154-14/24.06.03