Radiotherapy for secondary 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 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. This will depend on any infection control guidelines currently in place. 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.

What is secondary cancer?

Secondary cancer develops when cancer cells, which started in one part of the body (known as the primary cancer), develop and grow in another area of the body. This causes changes which can result in pain and/or swelling, bleeding or other symptoms. There may be a risk of bone breaking (a fracture) if it has spread to a bone.

Occasionally, the diagnosis of cancer is made unexpectedly following the investigation of persistent bone pain or fracture. Secondary cancer may also be referred to as a 'metastases' or 'metastatic cancer'.

Why use external beam radiotherapy to treat secondary cancers?

The aim of your treatment is to relieve your symptoms, reduce pain and to slow down the activity of the cancer in the treated area. Cancer can weaken the bone, so radiotherapy is also given to try to prevent fractures. When the risk of fracture is high, you may be considered for surgery which can involve metal pins or plates being placed into the bone to strengthen it.

Radiotherapy is often given a few weeks afterwards. The number of radiotherapy treatments you need depends upon a number of factors, such as which part of the body needs treatment and the size of the area. It is common to treat secondary cancer with one treatment, known as a single session. Sometimes, five or 10 treatment sessions, known as a course, or fractionated radiotherapy, are used. Your doctor or radiographer will explain how many treatments you will need and what side effects to expect.

You will need to attend the radiotherapy department as an out-patient, for a course of daily treatments from Monday to Friday.

Your radiotherapy planning appointment

Prior to your radiotherapy treatment starting, you will need to attend the radiotherapy department for a CT planning scan. This will be used to design your radiotherapy treatment. The position you are in for this scan will be the exact same as the position you will be in for your treatment. Please tell us if you find this position uncomfortable before we carry out the scan as there are often adjustments we can make to help make you as comfortable as possible.

Unless you have been told otherwise by your doctor, please continue taking your medications as normal before your appointment. If you take any medications to help manage your pain it is advisable to try to take these about half an hour before your appointment so that they are most effective while you are with us. This will make lying on the couch as comfortable as possible for you.

Your radiotherapy treatment appointments

Your radiotherapy treatment is similar to having an x-ray or a scan. Each session takes approximately 15 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.

If you took pain relief for your planning appointment or if you found the position you were in uncomfortable, we recommend you take pain relief for this appointment. If you feel you need additional pain relief, please discuss this with the radiographers who will be able to advise you or refer you to a doctor as needed.

We will regularly take x-ray images before your radiotherapy treatment begins to confirm that the area we intend to treat is in the correct position.

Short-term side effects

Some side effects are short term, or “acute”. Short-term side effects typically peak about two to three weeks after you finish your treatment and take 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 secondary cancers are:

Increase in pain

Within the first few days, you may notice a temporary increase in pain in the treated area, particularly if you have a single treatment. During this time, if any pain is not under control with your usual medicines, you should contact your GP, district or Macmillan nurse.

Feeling sick (nauseous)

Depending on the area being treated you may also feel nauseous following radiotherapy. The radiotherapy team will discuss this potential side effect with you and provide you with medication to help where necessary.

Diarrhoea

If you are having treatment to the abdomen (stomach) or pelvic (below the stomach) areas, you may notice that your bowel motions become more frequent and loose for a short time (diarrhoea). This occurs because we cannot avoid the bowel which lies in front of/close to the area(s) receiving treatment.

Bladder changes

Radiotherapy to the pelvis can sometimes include treating some of the bladder, which may cause temporary symptoms, such as the need to pass urine more frequently and discomfort when you wee. It is a good idea to drink more fluids until the symptoms settle.

Sore throat

When the back bones (spine) of your chest or neck area are treated, it is possible that your throat could become a little sore for a short time as these areas lie in front of the spine and may receive some radiation dose. If this soreness is troublesome, painkillers may be helpful as well as eating softer foods and avoiding very hot or very cold food and drink until it settles.

Cough or shortness of breath

When treating the chest, we may cause some irritation to the lungs which may cause a mild cough or some shortness of breath. This will settle a few days after treatment has completed. The radiotherapy team will discuss this side effect with you.

Loss of hair

You may lose some hair in the area where you have treatment. This often grows back but may be thinner and/or a different texture than before.

Discolouration of skin

Your skin may become discoloured in the treated area; this will usually be permanent. We advise you not to soak in hot baths, to use a mild, non-perfumed soap and to pat the area dry rather than rubbing. Please do not use talcum powder or any lotions and creams other than those advised by us. Please ask one of your radiographers for information on this.

Tiredness

You may become tired. Gentle exercise may help but save your energy for activities you enjoy doing. 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 start to occur more than three months after finishing your course of treatment, but sometimes much later.

It is unusual to have long-term side effects following a course of radiotherapy for secondary cancers, however please let your doctor know if this does happen – you may require additional tests and there may be treatments that can be offered to help.

After your treatment

Your follow up care after radiotherapy can vary depending on the treatment you have received. You may be referred back to your surgeon or 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. Out-patient appointments will then continue initially every three to six months, or more frequently if required.