Radiotherapy for oesophagus or stomach
This booklet will help you understand what will happen when you come to Velindre hospital to have radiotherapy treatment.
The booklet will explain how your treatment is planned and given. It will discuss side effects you may have and will tell you how to get more information and support.
A glossary is provided at the front of this booklet to help you understand any words that you may find unfamiliar.
Contact telephone numbers are given at the end of the booklet.
We hope this answers your questions. Please ask us if you have other questions that we have not covered.
Please bring a list of all the medication you are taking every time you come to Velindre.
Patient information is available on Velindre website please go to: www.wales.nhs.uk/cancercentre
Smoking is not allowed within the grounds and inside Velindre Hospital. If you need help giving up please ask us.
This information is evidence based and reviewed annually
Glossary of terms
Chemotherapy - a treatment for cancer using drugs
CT scanner (computerized tomography) - a machine that uses x-rays to take detailed scans of your body
Dietician - a person who helps patients to choose the best food to keep them healthy and strong
Physicist - a person who does the technical planning of radiotherapy treatment
Therapeutic radiographer - a person who will plan or give radiotherapy treatment
What is radiotherapy?
Your doctor has decided you would benefit from a course of radiotherapy to your oesophagus or stomach.
Radiotherapy is a treatment for cancer using high energy radiation, usually x-rays. The type and amount of radiation that you receive is carefully calculated to damage cancer cells, stopping them from dividing properly so they are destroyed. Your treatment will be planned to avoid as much healthy tissues as possible. However some healthy tissue is affected which causes side effects. Radiotherapy treatment can be given alone, after or instead of surgery. It can also be given with or after chemotherapy.
Radiotherapy team looking after you
The doctor responsible for your care is called a Clinical Oncologist. He or she, or one of their team will prescribe your radiotherapy treatment. This will be planned by a team of physicists and planning radiographers. The therapeutic radiographers will give you your treatment.
Velindre is a teaching hospital so your team may sometimes include a student radiographer, student nurse, or a medical student. If you don't want a student present during your clinic or treatment appointment, please tell your doctor or radiographer.
We will ask your name, address and date of birth every time you come to the radiotherapy department. This is to avoid any confusion.
During your treatment you will be seen by the review team. The team includes specialist radiographers with extra training to advise you on how best to deal with any side effects. They can also prescribe medication to help. They will provide information and advice on any practical, financial or emotional concerns you may have. If you feel you would benefit by speaking to the team; their number is at the end of this leaflet.
How many treatments will I need?
Radiotherapy is normally given Monday to Friday as an outpatient. The number of treatments you will need depends on many facts about you and your particular type of tumour. Your doctor will decide how many treatments are best for you.
Having chemotherapy with radiotherapy
If you are having chemotherapy, we will explain this part of your treatment and give you written information.
Transport to and from Velindre
Hospital transport is available but most people use their own transport. If you would like to use hospital transport, please give us as much notice as possible to arrange this for you. There is a high demand for transport so you will need to be prepared to wait for some time to be picked up and taken home. Spaces are limited so please consider traveling alone. Some local support groups can also arrange transport. Also, patients on particular benefits can claim travelling expenses, please ask when you come for your treatment.
Planning your radiotherapy
To plan your radiotherapy you will need to have a CT scan. We will give you an appointment in the planning department. This is at the front of Velindre hospital. This scan gives your doctor a detailed picture of the area that needs treatment.
You may see your doctor during this appointment if you have not signed a consent form for treatment. The doctor will discuss the benefits and risks of radiotherapy. It is your decision to go ahead with treatment, so please discuss any concerns you have before signing your consent form.
If you have already signed your consent form for treatment during your outpatient appointment you may only see the planning radiographers.
Picture of the CT scanner
We may need to inject a small amount of dye (called contrast) through a needle into your hand or arm before you have your scan. The dye helps to show the exact position of your tumour on the scan. It should not cause any ill effects. If you don’t need the dye for your scan this does not mean the planning of your treatment will be less accurate.
We may ask you to take off some of your clothing or give you a gown to wear. We will ask you to lie on the couch which is quite hard, with your arms up. Please tell us if you are not comfortable because you will need to keep this position, breathing normally, while we do the scan and for each day of your treatment. You will not see or feel anything during the scan. The radiographers will leave the room to turn the scanner on, but they will watch you very closely through a large window. The scan usually takes about 20 minutes.
We may need to draw one or more marks on your skin which we will use as reference points for your treatment. It is helpful for us if we can permanently mark these reference points, but we will ask your permission before doing so.
We will make a tiny dot by using the tip of a sterile needle to place black ink just under your skin. It is a permanent mark but is as tiny as a freckle. This will mean we have accurate marks to position you for your treatment every day, so you are able to wash during treatment.
A picture of a permanent ink dot
Starting your treatment
There can be a few weeks in-between your planning scan and the start of your treatment. This is due to the time needed to plan your treatment and when the next available slot is on your treatment machine.
Please let us know if there is any time that you would be unable to come for treatment. We will take this in to account when we book your treatment. Please tell us if you have any special needs that may affect your appointments, such as:
- Needing transport
- Having any other treatment (chemotherapy for example)
We will send you a letter or call you with your first appointment. We will give you the rest of your appointments when you come for your first treatment. If you have a problem with the appointment, please phone the radiotherapy booking clerk as soon as possible. If the answer machine comes on, please leave your name and phone number slowly and clearly. We will ring you back as soon as possible.
Your first radiotherapy treatment
If you are an outpatient when you come for your first treatment, please come to the radiotherapy entrance which is at the back of Velindre hospital. Give your name and hand your letter to the receptionist in the radiotherapy waiting room. They will tell you where to sit and wait or direct you straight to your treatment machine.
If you are an in-patient, one of the hospital porters will normally collect you and take you to the treatment machine. You may be treated at any time in the day, depending upon when there is a free slot on the treatment machine.
If you are due to have chemotherapy the same day as your radiotherapy, you will usually have chemotherapy first on the ward or day unit, then you will have your radiotherapy.
Your radiographers will chat to you before you go in for your first treatment. We will explain what will happen during your treatment and tell you about the possible side effects you may experience. We will give you an information leaflet about skin care during your treatment. Please ask any questions so we can put your mind at rest. We may need you to re-sign your consent form before you have your first treatment.
Occasionally unforeseen machine breakdowns can happen during your treatment. This may cause delays or cancellation of your appointment on that day. We will explain this to you in more detail on your first day.
There are different types of treatment machines but most people have their treatment on a Linear Accelerator (shortened to LA). They each have a number; for example, you may have your treatment on LA 4 or LA 5. The LA machines may look and sound different but they give the same treatment.
During your radiotherapy treatment
In the treatment room, we will ask you to lie on the couch in the same position you were in for your planning scan. We will position you carefully using the permanent reference marks made at planning. When you are in the correct position, we will ask you to lie still and breathe normally.
Your treatment may be delivered from different angles. On your first day of treatment we check your position at each of these angles before leaving the room to start your treatment. The machine can be controlled and moved to the different treatment angles by the radiographers outside the room. When the machine is moving, it may come close to you but it will not touch you. When the machine is switched on you won’t feel anything, but you may hear it buzzing.
Lying in the position for treatment
The radiographers watch you carefully on television monitors. If you feel uncomfortable while the machine is on please wave your hand. We can switch the machine off and restart the treatment when you are comfortable again.
Usually on your first day of treatment and at regular points afterwards, we will take pictures or scan the area that is being treated so you may be lying on the couch for a few extra minutes whilst this is done. The images are only used to help us check you are in the correct position for your treatment.
You need to lie still on the treatment couch for about 10-15 minutes, but the treatment itself (when you hear the buzzing noise) usually only takes a few minutes. When your treatment is finished, the couch is at a high level so please stay still until the radiographers have lowered the couch. You can then leave the treatment room.
Short term side effects of radiotherapy
You do not normally experience side effects straight away; any effects that you experience normally start after about 2 weeks of treatment. If you are having chemotherapy at the same time you may develop some side effects earlier. Side effects only affect the area of the body that we are treating.
Radiotherapy continues to work inside your body for up to 2 weeks after you have finished your treatment so any side effects you experience will continue for this time also. After about 2 weeks you will start to feel better, but everybody’s recovery time is different.
Tiredness (fatigue)
Radiotherapy can make you feel more tired than usual. You should listen to your body and rest if you need to but continue your normal activities if you feel able. Some people find a little exercise, drinking plenty of water and eating a healthy diet can help their tiredness. Walking can be very effective in helping with fatigue.
Skin reaction
Depending on how much treatment you need, your skin may become pink and warm, and may become dry and itchy. We encourage you to continue your normal skin care routine during treatment. We will discuss skin care on your first day of treatment. Most people will only have a very mild skin reaction.
Difficulty swallowing
Radiotherapy can cause your oesophagus (gullet) to become very sore and inflamed. This could make eating and drinking more difficult and painful. You may experience heartburn and indigestion. We can give you medication to help soothe this so that you can eat more easily. We can arrange for you to see a dietician during your radiotherapy if necessary.
Nausea and lack of appetite
You may feel sick or go off your food if we are treating near your stomach. We can give you anti-sickness tablets for this if you need it.
It is important to try to eat a healthy diet and drink more fluids during your treatment so that you do not lose weight. Eat several small meals a day rather than one big main meal if necessary. You can see the dietician who will give you advice on managing your diet. They can provide some build up drinks to help you to keep your weight steady if you are struggling with eating.
If you have a feeding tube in place you can continue to use this safely while having radiotherapy treatment.
Long term side effects
Longer term side effects are rare and don’t happen to everyone. They can develop months or even years after the treatment has finished. Your doctor will discuss this with you. Please tell us if you have any concerns.
Scar tissue can build up in the part of the oesophagus we have treated. This can make it narrower, so some foods may become more difficult to swallow. Please tell your doctor if you are having this problem. Changing to a soft food diet can help. If this becomes a severe problem a procedure can be done to stretch the oesophagus if necessary.
Although radiotherapy is accurately planned, a very small amount of normal lung tissue and sometimes heart tissue (depending on which part of the oesophagus we are treating) can be affected. This can cause scar tissue to form which may make you breathless.
Finishing your treatment
At end of your treatment you will be given an outpatient follow up appointment with your doctor. We will give you a follow up form with the details of your appointment and the telephone number of the review team to contact if you have any concerns after your treatment has finished.
If you need to change your follow up appointment, please ring your doctor's secretary. You can contact them by ringing the hospital and asking to be put through to their direct telephone line.
Contact telephone numbers
Velindre Hospital 029 2061 5888
Information, Support and Review radiographers 029 2061 5888 ext 6421
Radiotherapy booking clerks 029 2019 6836
Ambulance office 029 2061 5888 ext 6974
Dietician 029 2061 5888 ext 2214
Transport from Aberdare
The Rowan Tree 01443 479369
Transport from Bridgend
Sandville 01656 743344
Transport from Merthyr
Cancer Aid Merthyr 01685 379633
Helplines and websites
Tenovus freephone helpline 0808 808 1010
www.tenovus.com
Macmillan 0808 808 0000
www.macmillan.org.uk
National Oesophageal Patients Association 0121 704 9860
www.opa.org.uk
F.PI 9 Issue 7 July 2019