Patient Radiotherapy Journey

Planning or pre-treatment is the process of obtaining relevant information about the size area and shape of the area of the body being treated. This is most commonly performed using a CT scan, to obtain 3D images of the patient, which are used to create individualised radiotherapy plans which allow the treatment prescription to be written.

Depending on what area is being treated, there are several different processes and types of equipment used to prepare and plan treatment.

Radiotherapy Planning CT

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CT Planning

A radiotherapy planning CT scan is slightly different from a regular diagnostic CT scan. It allows radiographers to obtain 3D images of the area being treated in order to  create individualised radiotherapy plans. 

The scan itself will normally take between 10 to 15 minutes. However, sometimes there may be additional preparation for your scan, which can mean that the appointment may last up to 1 hour. A few patients will require an injection of a contrast agent (IV contrast), and some patients will need to drink a liquid before the scan (oral contrast); these help highlight important areas the doctors may want to treat or avoid.

During the planning procedure, measurements will be taken for your radiotherapy record. During this process it will be necessary to place small marks on your skin using a felt tip-type pen. At the end of the process, these marks will be made permanent, with your permission, by tattooing a small dot. This is so that prior to and during treatment, you will be able to wash as normal without losing the marks. 

 

 

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                                                      Planning Tattoo

 

Mould Room 

For some treatment types or areas, it may be necessary to have a device called a ‘shell’ or 'mask.' This is used to keep mobile areas such as the head and neck area or limbs stable and still throughout treatment. 

The process of making these will differ depending on what area of the body is being treated. When you arrive, the staff will explain the procedure fully before starting and answer any questions you may have.

These appointments can vary from around 15 to 45 minutes, and although they are often performed on the same day as your CT planning scan, on occasion you may be required to attend a separate appointment.

 

 

How many treatments will I have?

You may have a single treatment or a course of treatments, called fractions, over several weeks. This depends on why radiotherapy is recommended for you. Lower doses are given for palliative treatment than for curative treatment and usually over a shorter period of time.

 

 

When do I attend for treatment?

Radiotherapy is normally given Monday to Friday as an outpatient. The number of treatments you will need depends on many facts about you and your particular type of cancer. This can vary from a single treatment to a number of weeks of treatment. A course of radiotherapy may last for six or seven weeks. Everyone is different, and your doctor will decide how many treatments are best for you.

Most people receive radiotherapy as outpatients, travelling to the department each day. You might like to ask a friend or relative to come with you.

The staff will explain where you need to go and will try to arrange an appointment time that suits you. If you are staying in the hospital, the radiographers will arrange your treatment times with the ward staff.

It is important that you don’t miss any appointments, particularly if you are having treatment to your head and neck area. If you can’t attend for any reason, please let the radiographers know in advance if possible.

 

What happens when I come for treatment?

Each time you visit for treatment, a radiographer will ask you three questions to make sure you are the person they are expecting to treat. These are your name, address, and date of birth (even though they may know you).

The radiographers, who carry out your treatment, will explain things to you. If there is anything you don’t understand or if you have any questions, please ask them.

You may be asked to change into a gown before treatment, and then the radiographers will position you on the couch. Using the tattoos or marks that were put on your skin during treatment planning, they will line up the radiotherapy machine. It won’t usually touch you.

The preparation may take some time, often longer than the treatment itself. It will probably take longer on the first day. On most, if not all, occasions the radiographers will do some kind of imaging prior to delivering the radiation treatment to verify your position. When the radiographers are satisfied that you and the treatment machine are in the correct position, they will switch on the beam for treatment. You won’t feel anything during the treatment. 

The radiographers will watch you using closed-circuit television. and they can speak to you via an intercom. You should keep very still during the few minutes it takes to give your treatment, but you can breathe and swallow normally. The machine may move around you during treatment, or the radiographers may come in to change your position or that of the machine. They will explain each step to you.

The radiographers will give you special instructions, for example, about the care of your treatment area. Please try to follow these carefully.

You may need to reduce the hours that you work or cut back on social or sports activities. Make sure you get enough rest and accept offers of help with everyday tasks or jobs. If you are worried about anything or would just like to talk, your doctor, radiographer, or nurse will be happy to listen or advise.

The radiographer will check your progress regularly during your treatment, and you will see the doctor or nurse from time to time in a clinic. If you have questions at any time, do ask.

There are many people in the hospital that may be able to help and support you: If you would like to find out what services are available or how to contact a particular person, please ask.

 

Radiotherapy side effects

The side effects you may experience will depend on the part of the body that is being treated and how much treatment you have. Side effects only affect the part of the body that is treated. Everyone reacts to radiotherapy differently, and many people have hardly any side effects. The radiographers will give you lots of support and advice to care for and manage the side effects.

You will also be given written information about the side effects relevant to your treatment. Most side effects are temporary, and they are rarely severe. They may start at varying times during treatment and disappear in the weeks after the end of it. Some side effects may not start until treatment is finished.

Your doctor will discuss any possible temporary or permanent side effects with you before the start of your treatment and before you sign your consent form.

 

General side effects

Tiredness

Radiotherapy can make you feel more tired than usual. You should listen to your body and rest if you need to, but continue your normal activities if you feel able. Some people are able to continue working, but others find they are too tired. Tell your radiographer or doctor if tiredness is a problem. They may be able to offer advice on ways to save your energy and cope with everyday activities.

During your course of radiotherapy, you may have regular blood tests to check the effects on your general health. If the radiotherapy causes anemia, it may be necessary for you to have a blood transfusion.

Nausea and vomiting

A few people feel sick during radiotherapy; it depends on which part of the body is being treated. Some people feel sick at the beginning of a course of treatment but find that nausea often disappears within a day or two. Others start to feel sick later on.

Do tell the radiographers or your doctor if you suffer from nausea. You can be given drugs to control it, and it’s very unlikely that your radiotherapy will need to be suspended. 

Eating and drinking

It is important to try to eat well during your treatment and also drink about two liters of fluid (three to four pints) each day. This may not be easy if you are nauseous, tired, or spend a lot of time traveling to and from the hospital.

The dietitian can help you to plan your meals and can offer lots of hints about what to eat. Any of the team caring for you can contact the dietitian if you would like advice.

Hair loss

Radiotherapy can cause hair loss in the area being treated. Most hair loss is temporary, and it will start to grow back within two to three months of finishing treatment.

Sore skin

There is currently no general agreement based on research regarding caring for skin during radiotherapy. Advice on skin care varies from one hospital to another. The staff at your radiotherapy department will give you advice about how to care for your skin in the treatment area at the beginning of your course of radiotherapy.

During treatment the skin may become red and sore, and it’s important not to irritate it. Avoid shaving within the treatment area. You may wash the area gently using a mild, unperfumed soap, such as baby soap, and pat it dry. Don’t use any deodorants, perfumes, or lotions on your skin other than those recommended by the team caring for you. You should protect your skin from extremes of temperature and continue using sunscreen (factor 50 minimum) after your treatment has finished.

There has been little research into the effects of radiotherapy on different ethnic skin types. However, anecdotal evidence suggests that people with darker skin (for example, Asian or Afro-Caribbean) may develop greater skin reactions during treatment than people with lighter skin.

If you have any discomfort, the radiographers or nurses will advise you on skin care. The doctor may prescribe or suggest a cream or lotion for you to use. Swimming may not be advisable if you develop a skin reaction, as the chlorine in the water may irritate your skin. If you do swim during treatment, make sure you rinse the skin well and apply aqueous cream. Discuss this with your doctor, radiographer, or nurse.

Clothing

You may find it more comfortable to wear loose, casual clothing made from natural fibers. 

Joint or muscle stiffness

Occasionally, people who have radiotherapy to areas over joints or muscles may experience some stiffness. This can occur at any time up to two years after treatment has finished. Regular exercise of these joints and muscles can prevent stiffness. Your doctor may refer you to a physiotherapist. If not, please ask for advice.

 

Late side effects

Any side effects that may develop in the longer term and that may be permanent depend on the part of your body that has been treated, the dose of radiotherapy you have received, and many other things, such as why you are having radiotherapy. Your doctor will be able to explain these side effects and also the likelihood of them occurring. Do ask your doctor if you have any concerns.

 

If you have any questions or need support and advice now that your radiotherapy is finished, please contact the Radiotherapy Department in the first month following treatment. Contact us. Tel: 017765 235 465

Here are answers to some common questions about radiotherapy treatment.

Does radiotherapy treatment hurt?

When the radiotherapy is being delivered, the treatment itself is not painful. It is similar to having an X-ray or CT scan taken. Some people can feel pain or discomfort from the side effects of treatment or the often slightly awkward positions they need to lie in for treatment. If you have had surgery or other treatments, this might make the experience uncomfortable. Your therapeutic radiographers are there to support you. They will use equipment to make you as stable and comfortable as they can.

Some people find the experience very mentally challenging and experience strong emotions during treatment. Especially if they have to wear a mask or head frame, which can feel claustrophobic. You can talk to your team about any worries you have, and they will support you as much as possible.

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Am I alone during radiotherapy treatment?

During the actual treatment, you have to be alone, but your treatment team can hear and talk to you through an intercom and see you via CCTV. They will tell you how to signal if you need help.

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Will I be radioactive after treatment?

No, external beam radiotherapy does not make you radioactive. You can safely be around other people, including children and pregnant women, during and after your treatment. For internal radiotherapy (brachytherapy), there may be special precautions for a short time, which your healthcare team will explain.

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Should I take medications and/or vitamins while receiving treatment?

You can take your prescription medications as normal through radiotherapy. If you have any concerns about this, talk to your treatment team. Patients that take non-prescription therapies, vitamins, and supplements should ask their treatment team about this. Your team might suggest not taking them while you have radiotherapy if they could have a negative impact. For example, antioxidants might reduce the effectiveness of radiation on cancer cells.

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What kind of clothes should I wear?

You can wear anything you feel comfortable in. Remember that you will need to move or take off any clothes covering the area where you need treatment. If you wear clothing for faith reasons, you will need to move it or take it off, but your team will try to support you in feeling comfortable and dignified.

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Can I drive to and from my radiotherapy appointments?

Most people can drive during radiotherapy treatment. However, if you're experiencing fatigue or taking medications that might affect your driving, you may want to arrange alternative transportation. Discuss this with your healthcare team if you're concerned.

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Can I work during radiotherapy treatment?

Many people continue to work during radiotherapy, especially if their job isn't physically demanding. However, fatigue is a common side effect, so you may need to adjust your working hours or take time off. Your healthcare team can provide a medical note if needed.

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Can I miss a treatment?

For external beam radiotherapy, you would typically have weekday treatments. Treatments can range from a single session to daily sessions over a few weeks. Usually you can have the weekend ‘off’ and won’t have a treatment on Saturday and Sunday. To make sure the treatment works as well as possible, it is important that treatments are not delayed or missed unless there is a really good reason. If you must miss a treatment for medical reasons, your team will talk this through with you. If you are having a course of radiotherapy, it’s important not to book holidays or make plans that could cause you to miss a treatment.

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Does radiotherapy cause infertility?

Sometimes, yes, but this is dependent on many factors. It is more of a risk in children and young adults when the radiotherapy is near or treating organs that are part of the reproductive system. If this applies to you, your team will talk you through your options. This might include freezing and storing eggs or sperm. We know this can be a very difficult part of cancer treatment. Please see the links below for further information about fertility and cancer.