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Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. Radiotherapy is directed at specific parts of the body and may be given externally or internally.
External radiotherapy may be given before or after surgery. Depending upon the circumstances, it may also be given at the same time as chemotherapy.
The treatment is given in the hospital radiotherapy department as short daily sessions from Monday to Friday, with a rest at the weekend. The length of your course of radiotherapy treatment will depend on the type and size of the cancer. Your doctor will discuss the treatment with you.
Planning is a very important part of radiotherapy and makes sure that it is as effective as possible. On your first visit to the radiotherapy department you will be asked to have a CT scan or lie under a machine called a simulator, which takes x-rays of the area to be treated. The treatment is planned by a cancer specialist (clinical oncologist) and may take a few visits.
The radiographer (the person who gives you your treatment) will make small marks on your skin, to show where the rays are to be directed. During the course of treatment this area should be kept as dry as possible to prevent the skin becoming red and sore. Your radiographer will explain how to look after the area being treated.
Before each session of radiotherapy, the radiographer will position you carefully on the couch and make sure that you are comfortable. The treatment only takes a few minutes. You will be left alone in the room but will be able to talk to the radiographer, who will be watching you from the next room.
Radiotherapy is not painful, but you do have to lie still for a few minutes while your treatment is being given. The treatment will not make you radioactive, and it is perfectly safe for you to be with other people, including children, after your treatment.
Radiotherapy can cause general side effects such as feeling sick (nausea) and tiredness, but is also likely to make the inside of your gullet inflamed, causing short-term soreness when you swallow. It is not unusual to feel worse before things start to feel better.
Some people can find this a very difficult time and they may feel rather depressed for a while. These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. The clinical oncologist will be able to advise you on what to expect.
The radiotherapy may make your throat very sore towards the end of the treatment, and you may not be able to swallow properly for a while. Medicines are available that may help to relieve the discomfort caused by the sore throat. You may be advised to have a feeding tube put into your stomach (known as a PEG tube) before the radiotherapy starts. Your doctor can advise you whether or not this will be necessary.
PEG stands for percutaneous endoscopic gastrostomy and is carried out under local anaesthetic. A flexible tube with a light at the end (endoscope) is passed down the throat and oesophagus into the stomach, to find a suitable area to insert the tube. A cut is then made in the skin and muscle over the stomach and a tube passed through a cut made in the stomach itself. The tube is usually held in place with a rubber or silicon disk (flange). Liquid feeds can be given through the tube.
Our section on nutritional support discusses PEG tubes and feeding in detail.
If the radiotherapy is given to the upper end of the oesophagus, it may reduce the amount of saliva your salivary glands produce. This effect may be temporary, but occasionally can be permanent. This may make your mouth dry, which can make eating difficult.
Feeling sick (nausea) can usually be treated by anti-sickness drugs (anti-emetics), which your doctor can prescribe. If you don't feel like eating, you can replace meals with nutritious, high-calorie drinks, which you can get from most chemists. Our section on diet and cancer has some helpful hints on how to eat well. You can discuss any problems with your doctor.
When radiotherapy is used to treat the oesophagus, men may find that some of the hair on their chest may fall out.
As radiotherapy can make you tired, you should try to get as much rest as you can, especially if you have to travel a long way for treatment each day.
All these side effects should disappear gradually once your course of treatment is over, but it is important to let your doctor know if they continue.
This is given by inserting a radioactive metal rod, known as a source, into the oesophagus. It is left there for between 30 minutes and a couple of days, depending on the amount of radiation that is needed. In this way more focused treatment is given to the inside of the oesophagus in a short time, rather than a course of external radiation given to a wider area over a longer time.
There are two ways of giving this type of treatment:
Your doctor will put the radioactive source in the oesophagus using an endoscope – similar to the one used to diagnose oesophageal cancer. You will be given a sedative to make you feel sleepy so that the endoscope can be easily passed into your oesophagus. The radioactive source is contained within a tube that is placed next to the cancer. The endoscope is then removed. When the treatment is finished the doctor uses the endoscope to remove the tube containing the radioactive source.
A nasogastric tube (or NG tube) is a thin flexible, plastic tube that goes up your nose, down the back of your throat and into your stomach. Having a nasogastric tube put in can be unpleasant but should not be painful. The NG tube contains the radioactive source, which can be placed close to the cancer. When the period of treatment is over, the NG tube is removed.
Once the radioactive source has been removed, there is no remaining radiation within your body.
As with external radiotherapy, internal radiotherapy causes temporary soreness when you swallow, which may develop a few days after treatment and last for a few days. Your doctor will recommend liquid medicines to help you swallow and to soothe the soreness. Unlike external radiotherapy, this treatment does not cause tiredness or nausea and there is no hair loss.
If you have to stay in hospital for a few days while the radioactive source is in place, your family or close friends will only be able to visit you for short periods each day. It is not advisable to allow children or pregnant women to visit while you are having this type of radiotherapy. These precautions can make you feel isolated, but they only last for the few days that the radioactive source is in place. Once it has been removed the radioactivity disappears.
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