Radiotherapy leaflets

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Radiotherapy Department
Colchester Hospital
Tel: 01206 745 055

A guide for patients having radiotherapy to the breast or chest wall

What is radiotherapy?

Radiotherapy is a treatment for cancer which uses high energy X-rays. It is carried out using a machine called a Linear Accelerator or ‘Linac’

Having radiotherapy is similar to having a scan. It is painless and you need to lie still while you are on the treatment couch.

Radiotherapy is usually (but not always) given as a series of treatment sessions Monday to Friday. The number of treatments will depend on each patient’s specific treatment needs.

In most cases of breast cancer, the whole of the breast area or chest wall is treated. Your oncologist may also decide to treat some of your lymph glands.

The treatment is carefully planned, however, some healthy cells in the treatment area can be affected which can cause some side effects.

The treatment will not make you radioactive and it is safe for you to be with other people, including babies, children and pregnant women, throughout your treatment.

Support for radiotherapy patients

Macmillan Radiotherapy Advanced Practitioners

These are therapy radiographers with extensive experience in all aspects of radiotherapy treatment and care. They will provide:

• a direct contact to give support and specialist radiotherapy advice for you and your relatives and carers before, during and after a course of radiotherapy
• time for you and your family to talk through the information you have been given and discuss any concerns you may have
• a link with all doctors, nurses and other health care professionals involved in your care, both in the hospital and in the community. We can also refer you on to other health professionals or services, if necessary

Please ask a member of staff if you would like to speak to us or contact us by phone on 01206 745 025. We endeavour to answer your call straight away but if you leave a message for us we aim to respond within one working day.

Prescription medical exemption

All people undergoing treatment for cancer can apply for an Exemption Certificate by collecting a form FP92A from your GP surgery, oncology clinic or treatment department.

General information and arrival

The main entrance to the Radiotherapy Department is behind Gainsborough Wing (diagonally opposite the Constable Wing entrance). Alternatively you may use the main front entrance to the hospital and follow signs to the Radiotherapy Department.

Travel and car parking information

Get to Colchester Hospital

Patients undergoing radiotherapy treatment do not have to pay to park at the hospital. There is a car park designated for radiotherapy patients beside the radiotherapy main entrance behind Gainsborough Wing. You will be given information about entry to this car park when you are informed about your first radiotherapy appointment.

Hospital transport

Hospital transport can only be booked if you are not well enough to make your own way, or you have no alternative means of private or public transport available.

Important

If you use hospital transport, you should be prepared to be away from home for at least four hours. If you take regular medication or are diabetic, please make sure you have what you need with you when you come.

Children

Please note, that this hospital does not have a child-minding service. Children who cannot be left unattended cannot be looked after by staff.

Important Information relating to pregnancy

We are legally obliged to ask all persons of child bearing potential whether there is any chance of being pregnant.  If there is a possibility that you may be pregnant, you must inform a member of staff.

Clothing and gowns

We may ask you to change into a gown for your planning appointments and for all your radiotherapy treatments. For this reason it may be helpful for you to wear clothes that are easily removed. As the gown is tunic length is advisable for ladies to wear a skirt or trousers rather than a dress.

Planning your treatment

You will be taken into a room where your treatment will be discussed and any questions answered. We will ask you to sign a consent form if you have not already done so, to say that you agree to have radiotherapy, otherwise we will ask you to confirm consent.

For the next stage of your treatment planning process you will have a computerised tomography (CT) scan.

A CT scanner

Measurements and photographs will be taken.

After the scan we will ask your permission to make some tiny permanent ink marks with a pin prick on your skin. They are no bigger than a full stop (.) and will be used as reference points for all the measurements for your treatment. These will ensure treatment is accurate each day.

You may hear us refer to these as ‘tattoos’. If you have any concerns about having these markings please let us know when you attend your treatment planning appointment.

The information and measurements that we obtain from the CT planning session will be passed to our physics department, who will use it to produce a computerised treatment plan specifically for you. This is a complicated process and usually takes one to three weeks to complete. We will usually give you a provisional list of the dates and times of all your treatment appointments before you leave but please be aware that occasionally these may change.

Your treatment

When you arrive for your treatment, please report to reception.

Before your treatment you will be asked to change into a hospital gown and taken into a treatment room.

Radiotherapy treatment machine, Linear Accelerator

The radiographers will ask you to lie on the treatment couch. They will spend a few minutes positioning you correctly and precisely for your treatment. It is important at that stage that you remain as still as you can and follow any instructions given.

The radiographers switch on the machine from outside the room, so when all the adjustments have been made they will leave while you have your treatment. The machine makes a noise when it is operating so you will know when it is on. The radiographers are able to see you on CCTV. They can speak to you, if required, and can also hear you over the intercom, in the treatment room.

This routine will be the same every time you come for treatment until your course is completed.

How long will it take?

After only a few minutes your treatment will be over. Exactly how many minutes it will take will vary but you will be in the treatment room for 15 to 30 minutes.

How long will you be in the department?

We hope that you will be in the department no longer than 45 to 60 minutes each time you come but this might vary. If you come by hospital transport, however, you will be quite a lot longer than this. The transport is unable to take you back until all the patients who came with you have also been treated.

Patients may also reviewed by other members of the team during their course of radiotherapy and on these days you may expect to be in the department longer.

Sometimes these reviews may be done by telephone.

Side effects of radiotherapy

Your normal routine need not be greatly affected but you may feel tired. Some people are more sensitive to radiation than others and are more likely to experience side effects.

Unfortunately, there is no way of identifying these people before they are treated.

If side effects do occur, they will usually develop during the second half of your treatment and could last for some time after your treatment has finished. Recovery rates vary from person to person, so it is difficult to give an exact time for how long they will last.

Possible side effects

Tiredness

You may feel tired during your radiotherapy treatment, because the body has to repair damage caused by the radiotherapy to healthy cells. It can often be made worse by having to travel to hospital each day, or by other treatments such as surgery or chemotherapy.

What can be done?

• There is good evidence that physical activity can actually help to reduce the symptoms of fatigue. Get plenty of rest but balance this with some gentle exercise, such as short walks if you are able. This will give you more energy and help to keep your muscles working.
• Save some energy for doing the things you enjoy and ask others for help doing chores if these are tiring you out.
• Eating well can help to boost your energy levels.
• Drink plenty of fluids.

Sore skin (erythema)

During your radiotherapy and for a while afterwards you may develop a skin reaction in the area being treated. You may notice:

• your skin gradually becoming pinker or darker, depending on your skin colour
• the skin feeling dry and itchy or tight, and sore
• a rash appear and feel itchy
• sometimes the skin may blister or peel.  If this happens you will be given further help as you may need dressings

If you are having your glands treated as well, you may also find that a small patch of skin on your back becomes red and itchy.

A skin reaction may appear at any time but usually begins about ten days after starting treatment.

What can affect my skin reaction?

• Having treatment to areas where there are skin folds can make your skin reaction worse. This includes the breast, or armpit because they can be warm, moist and rub together causing friction.
• Smoking can make your skin reaction worse – if you need help to stop please ask for advice.
• A skin reaction is more likely if you are overweight, due to more skin folds.

A member of the radiotherapy team will talk to you about your usual daily skin care routine. They will let you know if any changes are advised. Please share any worries you have.

Swelling or soreness of the breast or chest wall

The tissues in the treated area can be irritated by the treatment and become swollen and you may experience some discomfort.

What can be done?

Usually, only time will help this problem, unfortunately. It can take up to a year after treatment has finished before it settles down completely. If you find it uncomfortable, try taking ordinary pain relief medication. If this doesn’t help, let us know.

Soreness of the oesophagus (gullet) or throat

It may be that some of your oesophagus (gullet) or throat is included in the treatment field (your treatment team can let you know if it is included). This may cause oesophagitis or throat soreness which may lead to some discomfort when eating or swallowing.

What can be done?

Please let us know if you experience problems because we can prescribe something to ease your symptoms, as well as giving dietary advice.

Skincare for patients having radiotherapy treatment

It may not be possible to stop a skin reaction but by following this advice you may feel more comfortable.

Important – this only applies to the skin in the area being treated. Please ask the treatment staff if you are unsure of the exact area of skin which will be affected by your treatment.

• Wash the skin gently with soap and warm (not hot) water and gently pat dry.
• Avoid tight clothing in the treatment area. If the breast area is being treated, avoid wearing an underwired bra.
• Wear loose fitting, natural fibre clothing next to the skin, such as a cotton T-shirt. Avoid rubbing the area.
• Avoid extremes of temperature, such as heating and cooling pads, hot water bottles and microwaveable wheatbags.
• Avoid or reduce shaving if possible, unless advised differently by your team.
• Avoid wax or creams for hair removal.
• Avoid sticky tape on the area (such as Elastoplast™ or Micropore™).

It may also help to reduce irritation to the treated area if you:

• Use a moisturiser sparingly – gently smooth it on and apply in the direction of hair growth. E45 cream or Aquamax cream (available from pharmacy counters) are examples of suitable moisturisers. If a cream irritates your skin, please stop using it and talk to your treatment team. If you’re choosing a new moisturiser, one that is free from sodium lauryl sulphate would be best. Ask the team if you are unsure about the cream you wish to use.
• Do not wipe moisturiser off before treatment. If your skin breaks or blisters you should stop using moisturiser. Your treatment team will advise you further.
• Avoid using products containing alcohol on the skin. This includes perfumes and aftershave. You may use deodorant, unless it irritates your skin. Please stop if the skin breaks.
• You may swim if your skin isn’t broken. Shower after swimming to wash off the chlorine and apply your moisturiser. Please stop swimming if it irritates your skin.
• Avoid sun exposure and protect the area from direct sunlight. Be careful in the sun for at least a year after you have finished. Use a sunscreen with a minimum UVB sun protection factor (SPF) of 50 and UVA protection, as your skin will be more sensitive than normal.
• Your treatment team will let you know if this advice changes during treatment.

Important: Please stop using any particular product which you think may be irritating your skin in the treatment area and ask your treatment team for advice. It may also help to keep up a good fluid intake and eat a nutritionally well balanced diet.

After your treatment has finished your skin will continue to be more sensitive. Your reaction may worsen for the following 7 to 14 days before starting to improve. Most patients find their skin has healed by about four weeks after treatment finishes. If the skin has broken, healing may take longer than that.

As your treatment progresses

Your oncologist will oversee your planning and treatment, and you will be monitored daily by the radiotherapy team.

Please always make sure that you let the radiographers know if you have any side effects. If you have a concern about side effects or problems that you wish to discuss and your appointment is after 3 pm, please call ahead well before your appointment time. The radiographers may advise you to come earlier to be seen by the appropriate member of the team.

What happens if you miss any treatments?

Right at the beginning of your course of treatment we will give you the dates and times of all your treatment appointments. Ideally, you should not miss any of these appointments. If you are ill and unable to come or something unforeseen happens which stops you having your treatment, however, your missed appointment(s) will be re-organised.

They will usually be added on to the end of your list.

After your treatment finishes

A follow-up appointment for 4 to 12 weeks after radiotherapy will be sent to you. Please call if you do not receive it.

Side effects of radiotherapy often reach their peak 7 to 14 days after treatment has finished. They will then gradually settle and improve over the following weeks and months.

Again, it is very hard to put an exact timescale on it because everyone’s recovery rate is different.

Important: Continue following our skin care advice until your skin reaction has settled, then start to return to your normal routine.

And finally …

Please share this booklet with your family and friends. It is important that they feel well-informed and understand what is happening. If you or your family need any further information, please do not hesitate to call – contact numbers follow.

Useful contact information

• Macmillan Advanced Radiotherapy Practitioners 01206 745025 – Monday to Friday, 8.30am – 4.30pm
• Radiotherapy Reception – 01206 745055
• Appointments / Transport – 01206 745033
• Radiotherapy nurses – 01206 745037
• Breast Care Nurses Colchester General Hospital – 01206 748370
• Breast Care Nurses Broomfield Hospital – 01245 513551
• Wellbeing Centre and Macmillan Cancer Information Centre, Colchester Hospital – 01206 745347
• Macmillan Cancer Information Centre Broomfield Hospital – 01245 515981
• Macmillan Cancer Support (Opens in a new window) – Freephone 0808 808 0000

Verifying your identity

When you attend hospital you will be asked to confirm your first and last names, date of birth, postcode and NHS number if you know it, and to let us know if you have any allergies.

Your experience matters

We value your feedback. Please help us improve our services by answering a simple question, in our online survey – “Overall, how was your experience of our services?”
This survey is known as The Friends and Family Test.

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