Radiotherapy for abdominal cancers

Although you may have heard about radiotherapy from friends, relatives or other patients, it is important to remember that their experience may not be the same as yours. In all cases, a doctor will explain your radiotherapy treatment to you and answer any questions you may have.

We are here to help, so if you would like further information or have any particular concerns, please do not hesitate to ask a radiographer or a member of the radiotherapy review specialist team.

In most cases, a friend, relative or carer may accompany you to your appointments. Please ask your doctor or a member of the radiotherapy team if this is possible.

What is radiotherapy?

Radiotherapy uses precise, carefully measured doses of high energy x-rays to treat cancer. Cancer cells are more sensitive to radiation than normal cells so the aim of treatment is for the xrays to either destroy the cancer cells or stop them from growing, whilst avoiding and protecting the normal cells as much as possible.

Radiation also damages normal cells in or around the area being treated which causes side effects, but these will usually recover and heal after treatment.

Why use external beam radiotherapy to treat abdominal cancers?

Radiotherapy may be given to treat and attempt to cure abdominal cancers as an alternative to surgery. Surgery may be reconsidered at a later date if the cancer returns, so you will be monitored after the radiotherapy treatment course finishes to see if this is necessary. It may sometimes also be used following surgery depending on the outcome of the procedure.

You will need to attend the radiotherapy department as an outpatient for a course of daily treatments (Monday to Friday), over a period of up to six weeks.

Radiotherapy may also be used to relieve symptoms from abdominal cancers if the cancer has spread outside the site where it originated to other parts of the body. This would be a shorter course of treatment with the aim of controlling symptoms and minimising side effects.

Chemotherapy

Some patients may receive a course of chemotherapy (where medicine is used to kill the cancer cells) prior to radiotherapy, this is known as induction chemotherapy. Chemotherapy may also be given during radiotherapy to try to make cancer cells more sensitive to radiation treatment. Both types of treatment are administered as an out-patient treatment.

If you require chemotherapy alongside your radiotherapy, you will also need to have weekly blood tests. These will normally be carried out on a Friday morning.

Chemotherapy may increase the risk of side effects, particularly infection and bleeding. For this reason, it is not recommended for all patients. If it is suitable for you to receive chemotherapy, you will receive specific information and resources from that team.

Some chemotherapy is given as an injection or infusion on selected days of your radiotherapy. This is normally given on one of the wards at the Royal Free Hospital. It is important on the days when you have this type of chemotherapy that you have the chemotherapy first and that you come to the radiotherapy department immediately afterwards so that radiotherapy can be delivered within one hour of chemotherapy finishing.

Chemotherapy can also be given in the form of a tablet. This will normally be given to you by a pharmacist in the radiotherapy department on your first day of treatment. The tablets are usually taken daily, but you will be given specific instructions by the doctor and pharmacist about the treatment and how often you should take it.

Sometimes the tablet chemotherapy can be given as well as the injection chemotherapy. The injection chemotherapy is given as an out-patient treatment on a ward and you will be instructed where to go, if this applies to you.

Your radiotherapy planning appointment

Prior to your radiotherapy treatment starting, you will need to come to the radiotherapy department for a CT planning scan.

You may be asked to fast before your CT scan appointment and before each of your treatments depending on the area you are receiving treatment to. Instructions on how to do this are in the fasting section below.

Some patients may be required to have abdominal compression as part of their treatment. This is used to reduce the amount your organs move during your normal breathing. It is not painful and if suitable, it will need to be used every day when you have your treatment. Abdominal compression involves a piece of equipment that looks like a belt, being wrapped around your abdomen which is then inflated.

Fasting

Depending on where in the abdomen we are treating, we may ask you to fast for two hours prior to your radiotherapy planning appointment and each of your treatment appointments.

During this time it is important that you do not eat anything. You may drink up to 200ml (one small glass) of water in this time. You will then be asked to drink 200ml of water just before your scan or treatment.

We ask you to fast to make sure your stomach is the same size each day. This can help us be as accurate as possible with your treatment.

Your radiotherapy treatment appointments

Radiotherapy treatment is similar to having an x-ray or other scan. If you fasted for your planning scan, you will need to follow the same fasting schedule prior to each treatment appointment. Each session takes approximately 15 minutes in total. Most of this time is spent ensuring you are in the correct position. The delivery of the radiation only lasts for a few minutes.

Sometimes it can take longer if your internal organs are not in the correct position. On rare occasions we may not be able to proceed with your treatment if we cannot be confident that it is going to be as accurate as needed.

Side effects of radiotherapy treatment

Short term side effects

Some side effects are short term, usually peaking about two to three weeks after you finish your treatment and taking a further two to three weeks to improve. However this will not be the case for all patients.

Possible short term side effects from radiotherapy for abdominal cancers are:

Discomfort in your chest

You may have some discomfort in your chest when you swallow. This can feel like heartburn or indigestion. It can even feel like food is getting stuck when you swallow due to irritation of your oesophagus (the tube which connects your mouth to your stomach). This can be lessened by eating a softer diet and by avoiding very spicy foods.

Coughing/breathlessness

You may develop a dry cough or become breathless.

Bowel irritation

The bowel may become irritated and you may experience some diarrhoea. Please let us know if this happens, so we can help you manage this effectively. You may also experience an increase in the frequency of needing to empty your bowels and an increased sense of urgency. In some cases, you may experience pain when emptying your bowels and find that you are passing more mucus or wind.

Skin discolouration

Your skin may become slightly discoloured over the treated area. We advise you not to soak in hot baths and to use a mild, non-perfumed soap. Try to pat the area dry rather than rubbing after a bath or shower. Do not use talcum powder or any lotions and creams other than those advised by your team. Cream is available from the radiotherapy review specialist if you need it and wearing loose, natural fibre clothing also helps.

Loss of body hair

You may notice that your body hair falls out in the treated area. This only happens in the area that has been treated and may grow back depending on the dose of radiotherapy.

Tiredness

Radiotherapy may make you tired. Gentle exercise can help but save your energy for activities you enjoy doing.

Smoking can make reactions to radiotherapy treatments worse so please speak to the radiotherapy review specialists for advice about cutting down. Information on how to stop smoking on our website.

Alcohol will make your throat feel uncomfortable so you should limit your intake. If you require advice on this, please speak to our radiotherapy review specialist or your doctor.

You may experience some or all of these side effects. Please always let the radiotherapy team know of anything worrying you, as we want to help you recover as soon as possible.

Long term side effects

Some side effects are long term. These usually occur around three months after finishing your course of treatment but can sometimes start much later.

Radiotherapy can cause tightening of the tissues of the oesophagus and for some people this makes swallowing more difficult. You will be given advice and treatment if this occurs.

The treatment can cause some scarring to your lungs, which may cause breathing problems or a cough. Your doctor will talk to you in detail about this if it applies.

Very rarely the rib bones may be weakened by radiotherapy which may make it more likely that you break a rib rather than just bruise yourself if you fall on them in the future.

Sometimes the liver can be affected by radiotherapy. If this is applicable to you your doctor will explain it to you and assist you in managing this if any side effects develop.

Please let your doctor know if you experience any of these side effects. You may require additional tests and there may be treatments that can be offered to help.

After your treatment

The type of follow up appointment you will receive after radiotherapy can vary depending on your treatment. You may be referred back to your surgeon or radiotherapy doctor follow up appointments.

You should expect an out-patient appointment to be arranged for you within four to six weeks after completing your treatment. This may sometimes be a telephone appointment. Out-patient appointments will then continue initially on a three to six monthly basis, or more frequently if required.