Radiotherapy for the colon, rectum or anus
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: https://velindre.nhs.wales/velindrecc
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
CT scanner (computerized tomography) - a machine that uses x-rays to take detailed scans of your body
Therapeutic radiographer - a person who will plan or give
your radiotherapy treatment
What is radiotherapy?
Your doctor has decided you would benefit from a course of radiotherapy to your colon, rectum or anus. Radiotherapy can be given before or after surgery, or to control your symptoms.
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 the cancer cells. This stops them from dividing properly so they are destroyed. Your treatment is planned to avoid as much healthy tissue as possible. However some normal tissue can be affected which causes side effects.
Radiotherapy team looking after you
The doctor responsible for your care is called a Clinical Oncologist. They will prescribe your radiotherapy treatment. This will be planned by a team of physicists and planning radiographers. A team of therapeutic radiographers will give you your treatment.
Velindre is a teaching hospital so your team may 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 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 during your treatment. You can speak to them at any point through your treatment.
How many treatments will I need?
Radiotherapy is normally given Monday to Friday as an outpatient. The number of treatments depends on many facts about you and your particular type of cancer. 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 charities 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. This scan gives your doctor a detailed picture of the area that needs treatment. We will send you an appointment to go to the planning department which is at the front of the hospital.
You may see your doctor during this appointment if you have not signed a consent form for treatment, the doctor will explain 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 during your outpatient appointment you may only see the planning radiographers. They will explain everything that is going to happen to you.
We would like you to have a comfortably full bladder for your planning appointment.
- Please empty your bladder
- Then drink 200 – 300ml (2 cups) of water about 30 minutes before your appointment
You will need to repeat this for all your treatment appointments.
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. This dye helps highlight particular organs within your body. 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.
During your CT scan 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, on your back, with your arms on your chest or by your sides. 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 be watching you very closely through a large window. The scan only takes a few minutes but you will be in the room for about 10-20 minutes.
Picture of CT scanner
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 to 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 mark
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 your 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, please come to the radiotherapy entrance which is around the back of the 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 on when there is a free slot on the treatment machine.
Your radiographers will talk to you before you go in for your first treatment. We will explain what will happen during your treatment and the possible side effects you may experience. We will give you advice about skin care during your treatment. Please ask any questions you have about your treatment.
Occasionally unforeseen machine breakdowns can happen during your treatment. This may cause delays and sometimes 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 L.A.). 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
You need to have a full bladder for your treatment. In the treatment room, we will ask you to lie on the couch in the same position you were for your planning. Please allow us to move you carefully in to the correct treatment position. You just need to lie still and breathe normally.
The machine can be controlled and moved 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 will hear it buzzing.
The radiographers will 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; 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.
Having treatment lying on your back
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 get off and leave the treatment room.
Short term side effects of radiotherapy treatment
You do not normally experience side effects straight away, but everyone’s reaction is different. Some people experience very few side effects. Any effects that you experience usually start after about 2 weeks of treatment. Side effects only affect the area of the body that we are treating. We will give you lots of support and advice to manage the effects.
Radiotherapy continues to work inside your body for up to 10 days after you have finished your treatment so any side effects you experience will continue for this time also. After 10 days you will begin to recover, length of recovery time is different for every person.
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, such as walking, can be helpful.
Skin reactions
Your skin within the treatment area may turn pink, feel warm, tender and could become sore and painful. We encourage you to continue your normal skin care routine until a skin reaction appears. We will discuss skincare with you on your first treatment. If you need any special creams or dressings we will prescribe them for you.
Diarrhoea
The treatment may cause some diarrhoea and increased wind or you may pass some blood. This can cause bloating and stomach cramps. Please ask your radiographer for advice on how to manage this.
Cystitis (burning when you pass water)
Radiotherapy may irritate the lining of your bladder. This can make you need to pass water more often and it can cause a burning sensation. It is important to drink lots of water during treatment to help with this.
Piles (haemorrhoids)
If you have suffered from piles, the radiotherapy treatment may irritate them. Please tell your review radiographers, they can prescribe suppositories or cream to help you feel more comfortable.
Late 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.
Due to a small part of your bladder being treated the bladder may not hold as much water as before therefore you may need to pass water more often.
As we have treated your bowel you will notice a change in your bowel habit and you may have some occasional diarrhoea or bleeding from the back passage. Please tell your doctor if you are concerned this is happening too much.
For women:
Menopausal symptoms
Radiotherapy can cause the onset of the menopause. You may have sweating (especially at night), hot flushes, irritability and mood swings, vaginal dryness, lack of sex drive and pass urine more often. Please ask if you would like advice about controlling these symptoms.
Infertility
The radiotherapy will stop your ovaries from working so you will become infertile. Please speak to your doctor if you are concerned about this side effect.
Vaginal narrowing, shortening and dryness
This may happen due to scar tissue developing in your vagina. Your vagina may also become less stretchy, making sex uncomfortable. Your review radiographers will offer advice on using dilators to help with this, after you have completed all your radiotherapy treatments. Dilators are plastic tubes, like tampons, which you put into your vagina, as far as is comfortable for you, turn gently and take out. You use them in the privacy of your own home. If you would like more advice regarding these side effects, please contact the review team for more help. See telephone numbers on last page.
For men:
Radiotherapy to the pelvis may cause erection problems and permanent infertility. There are many treatments to help. Please speak to your doctor or review radiographer if you are worried about this.
Finishing your treatment
Towards the end of your treatment we will give you an appointment for a follow up at a clinic with your doctor. This will usually be between one to six months after finishing your treatment. We will give you a follow up form. This gives you the details of your appointment and the telephone number of your review radiographers. Please ring the review radiographers if you are worried about your treatment or side effects after you have finished.
Contact phone numbers
Velindre Hospital 029 2061 5888
Radiotherapy booking clerks 029 2019 6836
Information, support & review radiographers 029 2061 5888 ext 6421
Transport from Aberdare:
Rowan Tree Cancer Care 01443 479369
Transport from Bridgend:
Sandville 01656 743344
Transport from Merthyr:
Cancer Aid 01685 379633
Helplines and websites
Tenovus freephone helpline 0808 808 1010
Macmillan Cancer Support 0808 808 0000
www.macmillan.org.uk
Bowel Cancer UK 020 7940 1760
Bowel Cancer | Bowel Cancer UK
F.PI 11 Issue 9 June 2019