Radiotherapy is a localised treatment and side effects depend on the area of your body
receiving the X-rays (in your case the rectum which is in the lower part of the
abdomen - pelvis).
There are three main types of radiotherapy to the
rectum:
- Short course radiotherapy It has been shown
in three large clinical trials that giving 5 fractions of radiotherapy in the
week before rectal surgery significant improves the chance of the cancer not
returning in the pelvis or elsewhere. This regimen is sometimes called the
Swedish technique and is usually given to rectal tumours which the surgeon and
radiologist feel are initially operable but have some adverse features.
- Long course radiotherapy This is given over 5 weeks accompanied
by low dose chemotherapy to sensitize the radiotherapy (make it more effective).
The surgeon then has to wait for 4-6 weeks for the side effects to settle and
the tumour to shrink before surgery is performed.. This is technique is reserved
for patients with large tumours where the surgeon and radiologist has doubts
whether it could be removed completely with surgery without it being shrunk
(down staged) first.
- Primary radiotherapy This is given in cases which cannot be
operated on. This is most often palliative (to reduce symptoms but unlikely to
cure) or if the patient cannot have an operation due to poor health. The
duration of this can vary form 1 - 6 weeks with or without chemotherapy
depending on the individual case.
Radiotherapy before surgery does increase the immediate
post operative risks slightly - mainly increase risks of infection and delayed
healing. Studies showed, however, at 6 months the complication rate with or
without radiotherapy was similar. As in all types of radiotherapy, there are two types of side
effects; those which come on during or immediately after treatment (acute side effects) and those which can be long term (late side effects). Your oncologist will have taken these
into account when considering the benefits of treatment and will inform you of the side
effects you are likely to get. Please discuss any concerns with your doctor, specialist
nurse or radiographer at the time of consent or at any time during radiotherapy.
This information sheet provides a brief introduction to
radiotherapy and explains the common side effects you may experience. This does not mean
you will definitely get them. It is also possible you may experience a side effect not
mentioned here.
Your first appointment
Your first appointment at the radiotherapy centre will be a planning session. This will
either be in the simulator or the CT scanner. Report to the reception
desk, show them your card, and they will direct you. You will then be welcomed by a
specialist radiographer, who is the person who operates the machines to plan and give your
treatment. Don't be embarrassed to ask him/her anything you are concerned about. The
purpose of this visit is to plan and arrange your radiotherapy so you may not have a
formal consultation with the doctor at this stage. Of course any urgent issues will be
addressed but others should be saved for the regular consultations you will have during
treatment. It is often difficult to judge exactly how long each patient will take - it is
possible you may wait a long time.
The simulator or CT
The simulator is a machine which is a direct copy of a therapy machine. It takes
X-ray pictures to enable the oncologist to decide the exact area of your abdomen which
needs treatment. While very accurate measurements are taken, you will have to lie on a
fairly hard couch which may be slightly uncomfortable. A small tattoo about the size of a
pin head is made on your body - giving a permanent record of the measurements.
The treatment machine
The treatment machine looks similar to the simulator. You will not be required to
do anything you haven't already done in the simulator. Although the radiographers are not
in the room while you are treated, you are being watched at all times on a camera. If you
feel any distress, the machine can be turned off and the radiographers will be at your
side within seconds. There is also an intercom which is left on. Treatment usually lasts
only 1 to 2 minutes. You usually do not have any unusual sensations when the machine is
turned on. After treatment you will not be radioactive and you will not lose the hair on
your head.
Potential side effects:
Acute side effects
Your appetite may be affected. If so, try to eat several small meals rather than
three large meals a day. Drink lots of fluid - try to double your normal fluid intake. If
you are worried about diet ask your radiographer to refer you to a dietician.
You may feel tired so it is important to get plenty of
rest.
Your bowels may become loose later in the treatment, possibly
causing diarrhoea. If this happens, cut down your intake of fruit, vegetables and
fibre and try to increase your intake of eggs, milk and other dairy products. Report any
diarrhoea to the doctor or radiographer as it may be necessary for you to have tablets.
Take these until the diarrhoea improves and then reduce them. Your bowels should have
returned to normal 2-3 weeks after treatment. You can then gradually re-introduce fibre
into your diet until you are back on a normal diet *** You should continue with
your normal diet unless you begin to get diarrhoea.
You may experience pain on opening your bowels (rectal pain).
Occasionally this may be associated with some blood in the stools.
If your bladder is in the treatment area, you may experience a
feeling of wanting to pass urine more often (cystitis). It is still possible to
develop a urinary tract infection so drink plenty of fluids and report any burning
feeling, on passing urine, to your doctor.
A feeling of nausea or sickness may occur during
treatment. Report any nausea or vomiting to your doctor as your symptoms can be relieved
with anti-sickness tablets. For larger treatment areas you will be given an anti-sickness
tablet to prevent nausea.
Your skin in the treated area may become red and sore,
especially in the skin creases. You take a shower during your treatment but it is not advisable
to sit and soak in a hot bath Avoid rubbing with a towel or scratching. If any soreness
develops report this to the radiographer who will give you advise.
Potential late side effects
The biggest risk of pre operative radiotherapy is delayed healing and infection
following surgery. If not having immediate surgery, for most people, the acute side-effects will resolve within 1 month. However, rarely some
continue to experience tiredness, diarrhoea, nausea, loss of appetite and cystitis for
several months although these usually improve with time. Around 10-50% continue to have
occasional diarrhoea and a few people may also notice occasional blood in the stools. Some
people will notice that they have to pass urine more frequently than before radiotherapy.
The majority of patients do not find these symptoms troublesome even if they persist
indefinitely. A few people may experience more serious side-effects (less than 5%). These
include narrowing of the bowel or bladder which may require an operation to correct the
damage.
In males fertility may be affected, depending on
the dose received. If relevant, sperm banking will be discussed with you. In women
fertility will be affected if the dose to the ovaries is high. On no account must you be
or get pregnant during radiotherapy as this will severely damage the baby. Radiotherapy
may bring on, or reduce the time to, your menopause the specific risks of this will
be discussed before treatment.
Additional general information
The cancerbacup booklet "Understanding
radiotherapy" can usually be obtained from the racks around the centre or
alternatively by phoning cancerbacup directly on 0800 181199. A copy of the
information film Chemotherapy & Radiotherapy can be ordered directly by
email only hep@clara.co.uk
Further general information Your doctors
and specialist nurses are in an ideal position to give you relevant information
on your disease and treatment as they know your individual circumstances. Cancerbackup
has a help line (0808 800 1234) and a prize winning video
available in English, Italian, Urdu, Bengali,
Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk
has over 500 pages describing cancer, its management, practical tips and tool
which patients, their carers and their doctors have found helpful during the
cancer journey.
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