Radiotherapy

What is radiotherapy? 

Your body is made up of lots (billions) of really tiny bits called cells. Normal cells can change into cells that grow in a different way to other cells (sometimes they are called ‘abnormal’ or bad cells). We don’t fully understand why this happens. These abnormal cells can multiply and grow into a lump. This lump is called a tumour.

Radiotherapy is used as part of your treatment to try to help destroy these abnormal cells. It uses X-rays (radiation) which are very accurately directed to a specific part of your body.  The radiation stops the abnormal cells dividing properly, injuring or killing them. Normal cells are also affected by radiotherapy but they are able to recover.

Why do I need radiotherapy?

You will already have had lots of tests and scans to find out what type of tumour or blood condition you have. Your doctor will therefore decide which treatment is best for you. This might include surgery, chemotherapy, radiotherapy or a combination. When you come for radiotherapy, there will be several members of staff involved in looking after you. They all work together closely to ensure you receive the best care and have a positive experience.

Prior to coming for radiotherapy, the team will meet with the patient and their family/carer. One of the team members will explain what radiotherapy is and what it is used for including the rational for radiotherapy for each individual patient. The procedure of planning and treatment and the early and late side effects will be spoken about in detail and any questions answered. The information required for each patient is tailored to their specific situation and requirements. 

The team will use visual, written and verbal information appropriate to the age of each individual and the needs of the family. The radiographer and/or play specialist will go through everything in a step-by-step fashion to ensure that all the patients’ needs are met.

For some children a general anaesthetic is required to ensure the safety and stability of the child. This is discussed and decided upon on a patient to patient basis. 

How is my radiotherapy planned?

Your radiotherapy is individually planned. You will visit the computed tomography scanner (CT scan). This is a computerised x-ray imaging procedure in where a narrow beam of x-ray is aimed at a patient and quickly rotated around the body, producing signals that are processed by the machine’s computer to generate cross-sectional images takes pictures of the inside of your body. These pictures are used to make your treatment plan.

You may have had a CT scan before however this scan is slightly different as it is done with you lying in the position needed for your radiotherapy. If you have a shell, special board of vac bag, it will be used for your scan.

Your radiographers might ask you to remove some of your clothing for your scan. They will cover you whenever possible and help you to lie on the CT couch. It is a little hard but you will not have to be there too long and your radiographers will make you as comfortable as possible. They will draw some temporary marks on your skin with a felt tip pen and place some small markers on top of these. These markers show up on your scan and will be removed when the scan is finished. If you are in a shell we may put the marks on that instead or as well as your skin. Your radiographers will move the couch into the CT scanner and leave the room. Don’t worry, they can see you through a window.  As you go through the scanner you will be aware of a quiet whirring noise but will not feel anything.  It is important that you keep nice and still during the scan.

How long will the planning take?

Your appointment can last between 30 and 40 minutes, but the actual scan only takes 2-3 minutes.

What happens when I come for my treatment?

Your radiographers will check some details with you, your parent or carer before you go into the treatment room.  This is to ensure that we have your personalised plan ready for you. When you enter the treatment room, you will see a large machine. This is the machine used to deliver your radiotherapy treatment and it is called a linear accelerator or linac.

As with the CT scan, your radiographer will ask you to lie on the treatment bed, again quite hard, but your radiographer will help to make you as comfortable as possible. You will lie in the same position as you did for your CT scan. If you had a shell, board or vac bag made, you will wear it for each appointment. It is important that you stay still to ensure that your treatment is given accurately.

The lights in the room will be dimmed. You might notice a light beam shining from the machine and some green or red lasers. Your radiographers use these and the marks on your skin, shell, board or vac bag, to position you correctly for your treatment. The bed moves up and underneath the machine. The machine may seem close but it will never touch you and will move around you during your treatment but your radiographers are controlling it, and they will explain everything to you. They will also be talking to each other to ensure you are in the correct position and checking your individual treatment plan before leaving the room. When the radiographers are happy, they will leave the room and are watching you at all times on CCTV. The procedure starts with a very quiet siren that will stop after a couple of minutes and you may also be aware of a red flashing light. They can play music for you, so please let us know if you have a song or artist you like or a story book. If you have an iPod or a mobile phone with music on it, you can also bring it with you.

Your radiographers are operating the machine from outside the room. They may take X-ray pictures before they start your treatment. This is another way for them to check you are in the correct position. Once they are happy, they will start your treatment. The machine will move round about you while it delivers the treatment, but it won’t touch you. You won’t feel anything and the treatment does not hurt.

How long does each treatment last?

Each treatment lasts around 20-30 minutes.

Will anyone be able to be in the room with me during my treatment?

No one else is allowed in the treatment room with you during your radiotherapy. Your radiographers will be watching you on a CCTV screen outside the room. If you are feeling a bit nervous the team can give you a long piece of special string to hold one end and your parent/carer will hold the other side from outside the treatment room. This helps you to know that they are just outside.

Why do I have to lie still during my radiotherapy?

It is very important that you lie still during your radiotherapy. This helps to ensure your treatment is accurate. If you cannot lie still, you will need to have a general anaesthetic each day. The anaesthetic is light and you will recover quickly from it. This means you will be able to go home after your treatment. If you are going to have a general anaesthetic, our team will give you more detailed information about this. Having a general anaesthetic can mean the treatment can take a little longer. You will also have to wait in the department until you have recovered and had something to eat.

Will a doctor see me during my treatment?

You will be seen weekly at the hospital where you will be checked to see how you are feeling and help with any side effects or other worries you may have. You can also talk to your radiographers or paediatric radiographer/ liaison nurse who will be happy to answer your questions.

What are the side effects of radiotherapy?

The side effects you experience will depend on which part of your body is being treated. Some parts of your body are more sensitive than others. You might not experience all of the following side effects. Take each day as it comes.

Tiredness  

Nearly all people having radiotherapy feel tired. This can happen whilst you are having your treatment and can last for some time afterwards. It is good to try to do some of things you enjoy doing and sometimes a little bit of exercise can help with your tiredness. It might help to go to bed a little bit earlier too.

Skin

• Sometimes the area of your skin being treated can become pink and warm. It may become dry and itchy and sometimes sore and red or even blister.  Points to help with irritated skin;
• If your skin gets irritated by the treatment, you can use Cetraben cream to help soothe it.
• You should wash your skin with lukewarm water and an unperfumed soap and pat your skin dry gently with a soft towel.
• If you are having treatment in an area that you shave, it is best to use an electric razor, or not shave at all until after the treatment has finished and your skin has settled down.
• Wear comfortable clothes. Loose clothing with cotton next to your skin can be best.
• You will need to protect the treatment area from the sun by covering up. When the treatment has finished, this area of skin will always be more sensitive to the sun.  You should therefore use sunscreen with both UVA/UVB protection with minimum SPF 50 while in the sun.
• We advise you not to swim while you are having radiotherapy as this could irritate your skin.

Eating

Try to eat a good variety of foods. Your body needs extra energy during treatment. Drink plenty of water to keep yourself hydrated. If you are having your tummy or pelvis treated, you may get diarrhoea. If this happens, you should try not to eat too many fruit and vegetables as these can make your bowels looser.

Hair 

Radiotherapy may make you lose hair in the area treated. If you are having chemotherapy as well, you may lose all of your hair.

Feelings and worries

Being diagnosed with a tumour can be a deeply distressing time for you and those closest to you. It is better to discuss your feelings with somebody rather than keeping them to yourself. If you don’t find it easy to talk to your family, you can talk to your radiographers, nurses, doctors, play specialist or clinical liaison nurse about anything. Sometimes you might find it easier to write down how you are feeling. You might find that you have a mixture of emotions all at once and that can be difficult.

What about school?

You can go to school every day during your radiotherapy if you are well enough and want to go. If you have had time off school, it can sometimes take a while to get used to being back. You may still get very tired and find it difficult to concentrate. People will understand. Speak to your teacher if you are struggling.

Will my friends understand?

Your friends will want to be there to help support you. Why don’t you give them this information to read to help them understand what you are going through?

Other sources of information and support

Teenage Cancer Trust
Young Lives Vs Cancer
Children’s Cancer and Leukaemia Group