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It will be given to you in addition to the information you will receive from your Clinical Oncologist (who is a specialist doctor in cancer treatment). His/her team will be caring for you during your treatment. This team will include radiographers and clinical nurse specialists but may also include speech and language therapists and dietitians.

The page describes radiotherapy planning and treatment. It also explains the side-effects which you may experience during and after treatment.
Each person’s treatment will vary, so the information given is a general guide. The healthcare team looking after you will explain your treatment and the side-effects in detail. If you have any questions after reading this page, please speak to the team looking after you or ring the numbers at the end of the page.

Staff will make every effort to meet your individual needs or will direct you to the person who can help.

All your radiotherapy planning and treatment will take place in the Radiotherapy Department on Level -2, Bexley Wing, Ģ��tv��Ƶ Cancer Centre (LS9 7TF).

Radiotherapy reception Tel: 0113 206 8940

Please do not bring any valuables into hospital with you as the Trust cannot accept liability for loss or theft.

What is radiotherapy?

Radiotherapy is the use of high energy X-rays and other types of radiation to treat cancer. The radiotherapy causes damage to cancer cells in the treated area. Although normal cells are also affected, they can repair themselves and are able to recover. Radiotherapy is a local treatment. This means it only affects the part of the body being treated.

Radiotherapy is often used as the main treatment for early stage cancer of the larynx. When you are having your radiotherapy you do not feel anything and it does not make you radioactive. You may hear a buzzing noise when the machine is switched on. It is perfectly safe for you to be around other people throughout your treatment. This includes children and anyone who may be pregnant.

You will have your radiotherapy on a treatment machine called a linear accelerator, as shown here in the photograph. You will see your radiographers at each treatment session. They will be happy to answer any questions you may have.

How often is it given?

Radiotherapy to the glottis is usually given over four weeks; this is a total of 20 treatment days. Treatment is generally given daily, Monday to Friday however your treatment may start on any weekday.

You may need to be treated on a weekend due to a bank holiday. We will let you know if this is the case. Your radiographer will be able to explain the details of your individual radiotherapy appointments.

Your treatment will usually be given as an outpatient.

Visiting us before your treatment

If you would like to visit the radiotherapy department before starting treatment, please call 0113 206 7603. This visit can be very useful as you can find out more information about radiotherapy.

Who will I meet?

Therapeutic radiographers

Radiotherapy is given by therapeutic radiographers of any gender. They are highly trained in the accurate planning and delivery of radiotherapy treatment. You will see your radiographers at each treatment session and they will be happy to answer any questions you may have.

Student radiographers

The radiotherapy department is a training centre for therapeutic radiographers. They are supervised at all times. If you do not wish students to be present, please speak to a member of staff. This will not affect your treatment or care.

Others involved in your care

You may meet other staff whilst you are coming for radiotherapy. Everyone you meet will introduce themselves, tell you their job title and explain the role they have in your care.

Important advice before your treatment

Pregnancy

It is very important that patients who could become pregnant, are not pregnant at the start of their radiotherapy course. Also, patients should not become pregnant during their radiotherapy treatment, as this can have an effect on the unborn child. Use an effective form of contraception, for example condoms, coil, depo injection or contraceptive pill.

For more information see the��‘Contraception and pregnancy during cancer treatment’��leaflet.

Please do not hesitate to ask your doctor or nurse if you have any questions or concerns.

Smoking

If you are a smoker we very strongly advise you to stop smoking before treatment. Continuing to smoke during radiotherapy will:

• dramatically reduce the chances of your treatment being successful;
• increase the severity of the side-effects during your treatment;
• increase the risk of serious longer term side-effects;
• increase your risk of developing further cancers in the future.

There are now several ways in which you can receive help to stop smoking.

You can ask your Clinical Nurse Specialist or GP for local contacts or further support.

Alcohol

Drinking alcohol during your radiotherapy treatment can cause mouth and throat ulcers. It is important not to drink alcohol at all during your treatment. Please see the helpline numbers mentioned towards the end of this page; they may be useful to you.

Planning your treatment

Your first appointment for radiotherapy will be a consent and/or planning appointment. Some patients may have already signed a consent form during a previous appointment with the Doctor. Other patients might have a consent appointment with us first, and return another day for the planning appointment. We will contact you by phone with the dates and times of the appointments. Directions to the hospital and transport arrangements will be discussed with you at this point.

Some tests and scans may be needed to help plan your treatment. We will explain which of these you will need when your appointment is made. You may see your clinical oncologist (or a member of their team) at this appointment. This is an ideal opportunity for you to ask questions. If you have not previously consented to your treatment you will be asked to sign a consent form.

What to bring with you:

• a list of all questions you may have;
• an up-to-date list of all the medications you are taking (including inhalers, sprays, vitamins or herbal products);
• any medication that you may need during your visit;
• something to eat and drink and something to occupy yourself with as this first visit can be quite lengthy (up to two hours).

Mould room

Radiotherapy involves exact positioning of the radiation beam, so you will need to stay very still while you are having treatment. To help you stay still we will make a mask for your head and shoulders. You will wear this mask for your planning scan and treatments.

You will be given an appointment to attend Mould Room where the masks are made. If you have any concerns about the mask, please let your clinical oncologist or a member of their team know. We have a support team who may be available to help you.

They can be contacted on 0113 206 7616 or email [email protected]

Your planning scan

In order to plan your treatment you will have a planning CT scan. This is done on a machine called a CT Scanner (see photo). It allows the images from the scan to be sent to the radiotherapy computer planning system.

There will be several members of staff present at your scan. These will include therapeutic radiographers, and possibly a mould room technician and a dosimetrist (the person who will produce the computer plan for your treatment).

Planning scans are not diagnostic examinations and will not be reported on as such.

The scan will be taken with you lying in the same position as for your treatment. The radiographers will draw some marks on you, to be used as a reference. Most of the other marks will be placed on your mask.

You will then be scanned, which will only take a few minutes. At the end of the scan the pen mark on the front of your chest will be replaced by a small permanent mark, also called ‘tattoo’.

These permanent marks help us to ensure that you are in the same position each day. It also means that you can wash without worrying about your marks coming off.

Following the scan the radiographers will give you the time of your first appointment on the treatment machine. This is most likely to be a couple of weeks after the planning visit. The radiographers will talk to you about any further appointments you have.

Radiotherapy Review Clinic (Princess Royal Suite)

Before starting your radiotherapy you will see someone from the nursing team in the radiotherapy review clinic. They will be able to advise you about how to look after yourself during your treatment. You will see them regularly during your treatment.

Having your treatment

When you arrive for your treatment you should go to the radiotherapy reception desk at the entrance of the radiotherapy department. On the first occasion you will be given a list of all your appointments. You will then be escorted to the waiting area for your machine.

The radiographers will explain what will happen and answer any questions that you may have.

You may need to partly undress and put on a gown. The radiographers will discuss this with you when you first attend the department.
The radiographers will position you on the treatment couch. They will fit your mask and adjust the couch and machine to the correct positions. Once you are in position, the radiographers will leave the room. A scanner (attached to the treatment machine) will take images first before treatment. This should only take a few more minutes.

These images do not monitor your condition but are purely for treatment accuracy.

You will be asked to stay as still as possible during the treatment but you should breathe and swallow normally.

The radiographers will be watching you on a closed circuit TV (CCTV) monitor during treatment. The CCTV camera is not recording or saving any images.

There is an intercom system so the radiographers can talk to you. If you would like to listen to music during your treatment, please let us know.
The treatment only takes a few minutes but you will be in the treatment room for about 10-20 minutes. The machine stops automatically after your prescribed dose of treatment has been given. The radiographers can stop the machine at any time if needed. The treatment machine makes a buzzing sound when switched on. You do not feel anything.

After the treatment is complete the radiographers will come back into the room.

On some days the radiotherapy department may be busy and there may be a delay before your treatment. We will keep you informed of any delays over 30 minutes. Please see the delay boards in the waiting areas. There may be occasions when you may have a longer stay in the department, or be asked to come at a different time. This is for example because you might see your consultant oncologist. It may be a good idea to bring something to eat and drink with you, including any supplement drinks you have been asked to have and any medication you may need.

It is very important that you do not miss treatment days as it may make your treatment less effective. If you feel you are unable to attend for any reason please telephone us so that we can discuss this with you. If you have any queries about your appointment times please discuss these with the radiotherapy co-ordinators on your treatment unit.

For appointment queries please ring the radiotherapy reception desk on: 0113 206 8940.

Clinic appointments

You will be seen each week in your consultant’s review clinic and in the nurse-led review clinic. These clinics are held in the Princess Royal Suite on Level -2 of Bexley Wing. You may also have appointments with the dietitians and speech and language therapists. These appointments help us to check how you are managing your treatment. You will be asked about your diet, swallowing, pain control and any other symptoms that you may have. If you have any problems, please let the radiographers on your machine know.

Speech and swallowing during radiotherapy

Radiotherapy to the head and neck area can sometimes affect your ability to swallow, eat, drink, and speak. These changes may develop gradually during treatment and can vary from person to person.

You may notice that swallowing becomes more uncomfortable or painful. Food and/or drink may feel like it is sticking, or ‘going down the wrong way’. This may indicate an unsafe swallow. Your speech or voice may also change if the treatment affects the muscles and tissues involved.

Speech and Language Therapists (SLTs) can help in assessing and managing swallowing and communication difficulties. You may meet an SLT before starting radiotherapy, or you may be referred during treatment if you experience any concerns.

What Can You Do To Help Your Swallow?

There are several simple things you can do to help make eating and drinking safer and more comfortable:

• Continue to complete any swallowing exercises advised by your SLT throughout your treatment. These exercises help keep the swallowing muscles active and can support your recovery.
• Take your prescribed medications as directed. If you continue to experience pain or discomfort when swallowing, please inform the nurses as soon as possible.
• Choose softer foods if eating becomes difficult. Moistening food with sauces, gravy, or other liquids may make swallowing easier. You may also be advised to avoid hard or crumbly foods.
• Eat and drink slowly, taking small mouthfuls and allowing yourself plenty of time. Avoid rushing meals.
• Reduce distractions during meals where possible. For example, turn off the television and avoid talking while eating and drinking so you can concentrate on swallowing safely.
• Sit upright when eating and drinking, with your head in a comfortable, neutral position.

Keeping Your Swallow Safe

You may be asked to see a SLT to assess the safety of your swallow. Sometimes, during radiotherapy treatment your ability to protect your airway when you swallow can be affected. You may be at risk of food and/or drink going down into your lungs. This is called ‘aspiration’ and may cause a chest infection. If your swallow is unsafe, you may be advised to use a feeding tube (please see the section about Tube Feeding further on this page).

Please let a member of the team know if you experience any of the following when eating and drinking:

• Coughing
• Choking
• Wet “gurgly” voice
• Food or drink sticking in your throat

For most people, swallowing improves as the side effects of radiotherapy settle after treatment. However, recovery is different for everyone, and some people may continue to experience swallowing difficulties in the longer term. Your SLT will work with you to provide ongoing assessment, advice, and support throughout your recovery.

Side-effects

Side-effects can be divided into short term (acute) effects that happen during or soon after treatment, and long term effects occurring months or years later. Some side-effects are common, whilst others are rare. Your oncologist will discuss this with you. If you develop any radiotherapy side-effects you will be given advice and support by your healthcare team.

Possible short term side-effects

Most short term side-effects are common and are temporary. Side- effects tend to build up from about the second week of treatment. They will be at their worst at the end or just after the treatment course. They generally last a number of weeks or months after the treatment has finished.

Skin reactions

The skin in the treated area starts to redden or darken about 10 days after the start of radiotherapy treatment. It may become dry and itchy.

Sometimes later in treatment it may peel and become weepy.
Avoid hair removal where possible, including shaving, waxing, cream and lasers unless advised otherwise by your consultant, nurse or radiographer.

Before you go in for your treatment the radiographer will explain what will happen to your skin and how to look after it. They will also give you a leaflet to take home.

If you are concerned about your skin reaction please talk to your radiographers or contact the review clinic nursing staff, telephone: 0113 206 7587.

Tiredness (fatigue)

Nearly all patients having radiotherapy will feel tired. Be prepared to take things easy during treatment and allow for extra rests. Try to continue with some of your normal routines and activities if possible.

Fatigue usually improves in the weeks to months after treatment.
Things you can do to help include:

• Gentle exercise can help reduce the symptoms of fatigue.
• Having enough to drink can prevent tiredness from dehydration.
• Small meals or snacks eaten more often than three times a day may be easier to face.
• Try to get a good night’s sleep where possible, a daytime nap may help.
• Try to ‘pace’ yourself, listen to what your body is telling you, rest if you need to.
• Pick out the things that you enjoy, and try to accept help with other tasks.
• Little and often is the rule of thumb.

There is a Macmillan information leaflet available called ‘Coping with fatigue’. If you would like a copy, or support with your fatigue please ask a member of staff.

Sore throat and throat ulcers

A sore throat or throat ulcers often develop after about two weeks of treatment. It can make it more difficult to eat and drink because it might be:

• painful,
• too much effort or
• unsafe if ‘things go down the wrong way’

We will give advice to help you keep up your calorie intake and prescribe painkillers to make you more comfortable. Once the soreness settles after treatment you will be able to reduce your painkillers. If you have any queries about your painkillers after treatment please contact your consultant’s team or your GP.

It is important that you are well nourished and drink plenty of fluids during your treatment. Try to avoid losing weight.

The radiographers will monitor weight loss as they position you for treatment each day. We may ask you to see one of our specialist dietitians. Your weight and diet will be checked at the start and regularly through treatment.

When you are part way through treatment, you may need to change to a softer diet. We can give you liquid food supplements if needed. It is very likely that eating will not be enjoyable during treatment. However, it is still important to try and keep up a good intake of calories.

Chest infection (Rare, less than 1%)

This can be life threatening. You must tell the radiotherapy team immediately if you suspect you are developing a chest infection. This may include:

• Spiking a temperature
• Feeling short of breath
• Noticing a change in the colour of your phlegm, commonly yellow/green
• Noticing a new ‘wheeze’ when breathing
• Chest tightness

Sometimes chest infections can be caused by food, drink or medication going ‘the wrong way’ – into your lungs rather than your stomach. This is referred to as ‘aspiration’.

Feeding tube

If your swallowing becomes too uncomfortable or unsafe, you may not be able to get enough calories from food and supplements. In this case a feeding tube may be recommended by your team. This is usually only a temporary measure. You should be able to swallow safely once the radiotherapy side-effects have fully settled.

Sticky phlegm (‘throat secretions’)

You may produce more or thicker phlegm towards the end of treatment. This can be uncomfortable and make you want to cough. We may suggest using a nebuliser to help with this issue. Drinking soda water can help loosen the secretions.

Loss of voice

Your voice box can become inflamed and your voice may become hoarse, husky or disappear completely later in treatment. Your voice strength will generally return within a couple of months after treatment. Your SLT will support you with this.

Constipation

Your bowel habit can be affected by changes in your diet and using painkillers. It is important to keep using your painkillers regularly. However, please let us know if you are having difficulties opening your bowels (if you’re struggling to have a poo).

When radiotherapy has finished

Your side-effects may get worse in the first few weeks after treatment and will then gradually settle. You should start getting back to normal about 4-6 weeks after treatment but it may take a little longer. Tiredness can last for several months and you may need to continue to rest more than usual.

You may be asked to attend the hospital where you were first seen by your oncologist for follow-up checks at regular intervals.

Possible long term side-effects

Long term side-effects can happen months to years after your radiotherapy. The list below can seem alarming, but please remember serious late side-effects are very rare.

• Skin changes: occasionally the skin may be discoloured (usually darker), thickened (fibrosis) and there may be small ‘spider’ blood vessels visible near the skin surface;
• Chest infections as a result of swallowing difficulties;
• Hoarseness: you may experience a change in the quality of your voice;
• Underactive thyroid gland causing a lack of thyroid hormones. This can be easily treated with tablets. This can happen quite a long time after the radiotherapy;
• Laryngeal chondronecrosis, which is irreversible damage to the voice box. Occasionally surgery may be needed to correct this. This is a very rare side-effect;
• Damage to the blood vessels; this may lead to a slightly higher risk of stroke;
• Swallowing problems with risk of long-term feeding tube requirement. This is a less common (less than 10%) side effect.
• Cancers caused years later by having radiotherapy are very rare.

Late skin effects:

• Three months to a year after treatment your skin can appear ‘shiny’ and will also be dry. Look after your skin by using a moisturiser every day. Please note, during treatment only use the skin care products advised by your radiotherapy team.
• Tiny ‘spider’ veins can appear after a year and are permanent. If you are worried by the appearance you can use cosmetic camouflage with a special hardwearing concealer – ask the medical team about this.

Research at Ģ��tv��Ƶ Cancer Centre

Ģ��tv��Ƶ Cancer Centre is a major centre for cancer research.

You may be asked if you would like to help with some of the clinical studies. You are under no obligation to take part in any trials. Your treatment will not be affected in any way if you do not wish to take part.

If you do take part in a clinical trial you may meet a research nurse or radiographer. They will be helping to run the trial.

Further information and support

If you have any questions please ask your hospital team.

We all have our own ways of coping with difficulties. Some people have a close network of family and friends who provide emotional support, others would rather seek help from people who are not involved with their illness.

The following are also available as sources of information and support that you may wish to use.

Clinical Nurse Specialists (CNS)

Your CNS is available to discuss any aspect of your treatment with you. You will be seen by a CNS before your treatment. This is to offer support and advice about the practicalities and effects of treatment and answer any questions you may want to ask.

Your CNS will also assess and discuss any physical, psychological, social, occupational or spiritual needs that you may have. They can refer you to other services if needed, for instance, benefits advice.

You should be given a ‘key worker’ as a contact for support through your treatment; this is usually the CNS.

Macmillan Specialist Radiographer and Macmillan Radiotherapy Nurse Specialist

Sometimes people need more help if they are feeling depressed, very anxious or are having problems with their treatment. If this is the case you may benefit from seeing the Macmillan radiographer or nurse specialist. Your oncologist, radiographer or nurse can refer you at any point before or during treatment.

Local Support Services

Ģ��tv��Ƶ Cancer Support

Ģ��tv��Ƶ Cancer Support complements care provided by your clinical team. We offer access to information and a wide range of support, in a welcoming environment for you, your family and friends.

We can be found in the information lounges in Bexley Wing and also in the purpose built Robert Ogden Macmillan Centre (behind the Thackray Medical Museum).

The Robert Ogden Macmillan Centre

The Centre is on the St James’s Hospital site and offers a variety of support services including complementary and supportive therapies.

Contact numbers for Ģ��tv��Ƶ Cancer Support

All the above services can be emailed on:
[email protected]

Maggie’s Centre

If you or someone you love has cancer you may have lots of questions. Maggie’s is a warm, welcoming place where you can meet people who are experiencing similar things to you.

You may also be able to find support groups specific to your needs and get advice and information from their professional staff.

You don’t need an appointment and all support is free.

Address: St James’s Hospital (next to the multi-storey car park), Alma Street, Ģ��tv��Ƶ LS9 7BE

Email: [email protected]

Website:

National Support Organisations

Car Parking

When you are coming for radiotherapy planning and treatment your parking is free in the on-site multi-storey car park. Please ask for more information at the radiotherapy main reception desk.

Hotel Bexley Wing

Patients having radiotherapy or chemotherapy sometimes use the hotel if they have a long way to travel. The hotel is located on the 8th floor of Bexley Wing and offers 19 twin rooms and 1 single room. All have en-suite, tea and coffee making facilities, a mini fridge, towels, hairdryer and digital television. There are two rooms with wheel chair access and a wet room. Patients are able to stay free of charge. There is no charge for a relative staying in the same room as the patient. However, there is a charge for relatives if they need their own room. Availability for this cannot be guaranteed.

Meals can be purchased (at breakfast and lunch) if you are able to make your way to the restaurant in the Bexley atrium. At other times you will need to have something you have brought from home or purchased. There is a very small fridge for your personal use.

There are no staff after 3.45pm until the next morning in this facility.

For further details please contact the Hotel Receptionist on 0113 206 7687, Monday to Friday 8.00am – 3.45pm.

How to find us

St James’s University Hospital – site plan