Radiotherapy for oesophagus and stomach cancers

Although you may have heard about radiotherapy from friends, relatives and/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.

The aim of treatment is for the x-rays 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 oesophagus and stomach cancers?

Radiotherapy may be given to treat and attempt to cure Oesophagus and Stomach Cancers (radical radiotherapy), 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.

Radiotherapy is sometimes also used following surgery if this becomes necessary.

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 Oesophagus and Stomach Cancers, when the cancer has spread outside the site where it originated to other parts of the body (palliative radiotherapy). 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 prior to radiotherapy (induction chemotherapy). Chemotherapy may also be given during radiotherapy (chemo-radiation), to try to make cancer cells more sensitive to radiation.

Both are administered as an out-patient treatment. If you require chemotherapy with your radiotherapy, you will need weekly blood tests while you are on treatment, which we will usually aim to do on a Friday morning.

Chemotherapy may increase the risk of side effects, particularly infection and bleeding, and so will not be recommended for all patients. The chemotherapy team will give you specific information leaflets on chemotherapy if it is recommended.

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 where you have this type of chemotherapy that you have the chemotherapy before your radiotherapy treatment. You will come directly to the radiotherapy department after your chemotherapy so that we can deliver your radiotherapy treatment within one hour of your chemotherapy finishing.

Some chemotherapy is 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 and they will explain the details of this treatment to you.

These tablets are usually taken daily, however your specific instructions will be given to you by the doctor and pharmacist. Sometimes the tablet chemotherapy can be given as well as the injection chemotherapy.

Your radiotherapy planning appointment

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

You may be asked to fast for two hours before your CT scan appointment and each of your treatments depending on the area to be treated. If you have been asked to fast, you will be given 200ml water to drink 10-20 minutes before your scan.

Depending on the area to be treated they may arrange for you to have a specially made mask to help keep your neck still during your treatment. They will explain this to you if it is needed.

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 will need to be used every day when you have your treatment. It involves a piece of equipment being wrapped around your abdomen which gets inflated.

Fasting

If we are treating the lower part of the oesophagus or the stomach, we will ask you to fast for two hours prior to your radiotherapy planning appointment and each of your treatment appointments.

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

We ask you to fast because if your stomach is a different size each day, it can move the area which we are intending to treat, making it more difficult for us to make your treatment as accurate as possible.

Your radiotherapy treatment appointments

The actual radiotherapy treatment is like having an x-ray/scan. You will need to follow your fasting schedule prior to each appointment.

Each session takes approximately fifteen minutes in total, most of which is spent ensuring you are in the correct position, although the actual delivery of the radiation lasts only a few minutes.

We will check that your internal anatomy is in the correct position each day before treating. If it is not this may mean that you may be in the department for significantly longer on days where this needs correcting.

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 required.

Radiation induced short term side effects

Some side effects are short term, or “acute”. Short term side effects typically reach their peak about two to three weeks after you finish your treatment and take a further two to three weeks to reduce. However this will not be the case for all patients.

Examples of possible short term side effects from radiotherapy for oesophagus and stomach cancer are listed below.

• 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 swallowed due to irritation of your oesophagus. This can be lessened by eating a softer diet and by avoiding very spicy foods. The radiotherapy review specialists can help you manage this.
• You may feel sick. The radiotherapy review specialist can help you manage this. If you have difficulty eating because of nausea or pain, they can help you manage this and refer you to a dietician if needed.
• Radiotherapy may irritate your airway and lungs. The treatment is planned so that this is kept to a minimum, but you may develop a dry cough or become breathless. Please let the radiotherapy review specialists know about this so they can help you.
• Your skin may become slightly discoloured over the treated area. We advise you not to soak in hot baths. Use a mild, non-perfumed soap and pat the area dry rather than rubbing it.

Do not use talcum powder or any lotions and creams other than those advised by us. Cream is available from the radiotherapy review specialist if you need it and wearing loose, natural fibre clothing also helps.

• 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.
• Radiotherapy may make you tired. Gentle exercise can help with your recovery.
• Smoking can make your radiotherapy reaction worse so please speak to the radiotherapy review specialists about cutting down.
• Alcohol will make your throat uncomfortable, so we advise that you limit your intake to a very occasional glass of wine, beer or watered down spirit.

You may experience some or all 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 more than three months after finishing your course of treatment but sometimes can start much later.

• Radiotherapy can cause tightening (stricture) 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 if you fall on them in the future.
• The spinal cord lies very close to the oesophagus. Very rarely, people can experience problems with nerve weakness or pain because of radiotherapy, but the planning process is designed to ensure the spinal cord receives a safe dose of radiotherapy.

Please let your doctor know if this happens. You may require additional tests and there may be treatments that can be offered to help.

After your treatment

Follow up from radiotherapy can vary depending on the treatment you have received. Sometimes you may be referred back to your surgeon for follow up and sometimes you will be followed up by your radiotherapy doctor.

Usually, you should expect an out-patient appointment to be arranged for four to six weeks after completing your treatment.

This may sometimes be a telephone appointment. Outpatient appointments will then continue initially on a three to six monthly basis, or more frequently if required.