Radiotherapy for Skin Lesions

The leaflet 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 hear any words or phrases that you do not understand, please ask your doctor or a member of your healthcare team what it means. It does not matter how many times you ask.

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, Leeds Cancer Centre (LS9 7TF).

What is radiotherapy?

Radiotherapy is the use of high energy x-rays and other types of radiation to treat cancer. Radiotherapy causes damage to the cancer cells in the treated area. Although normal cells are 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 that is treated.

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 with other people, including children and anyone who may be pregnant, throughout your treatment.

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, and they will be happy to answer any questions you may have.

How often is it given?

Radiotherapy is usually given over one day to six weeks. This is a total of between 1-30 treatment days. Treatment is usually given daily, Monday to Friday; however your treatment may not start on a Monday.

You may need to be treated on a weekend during the day due to a bank holiday and 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 and ask questions.

Who will I meet?

Therapeutic radiographers

Radiotherapy is given by therapeutic radiographers of any gender, who 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 people who can become pregnant, are not pregnant at the start of a course of radiotherapy. Also, do not become pregnant during a course of radiotherapy because it 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 about these issues.

Planning your treatment

Your first appointment for radiotherapy will be a planning appointment. This will be used to gather all the information we need to accurately plan your treatment. We will contact you by phone, with an appointment for your radiotherapy planning session. Directions to the hospital and transport arrangements will be discussed with you at this point.

At your first appointment you will see your Clinical Oncologist in the Princess Royal Suite (Planning Clinic). The oncologist will explain your treatment. 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. Please do not wear make-up to cover the area when coming for your planning appointment.

The oncologist needs to see the area to be treated clearly. The area to be treated will be drawn around using a skin marker pen.

These marks will be removed before you leave the department. A photograph and a template of the treatment area will be taken and used by the radiographers for each treatment. The template may be used to make an individual protective shield that outlines the treatment area.

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

If your skin lesion is on your face or head, you may need to visit the Mould Room to have a perspex mask (see photo) or wax mould made. If you have a mask made, you will need to wear the mask for treatment. This helps you stay in the right position.

You may need one or two visits to have your mask made. These appointments are usually a week apart. Please ask for the ‘Having a radiotherapy mask made’ information leaflet.
You may also need customised lead shielding to protect healthy parts of your face, such as your eyes; it depends on the area that is being treated. Sometimes we place ‘bolus’ on your skin during treatment. ‘Bolus’ is a jelly-like material that helps in radiotherapy delivery.

If you need lead shielding or wax or bolus these will be applied during your treatment and removed before you leave the department. If you have any concerns about the mask, please let your clinical oncologist or a member of their team know. They can contact the Radiotherapy Patient Support team who may be able to help you. Alternatively you can contact the Patient Support team.

Your Planning Scan

Depending on your diagnosis, you may also have a CT scan. This is called a CT Planning scan. This is done on a machine called a CT scanner, shown here in the photo.

This is a CT scanner that allows the images to be sent to the radiotherapy computer planning system. There will be several members of staff present at your scan: radiographers and possibly a mould room technician and a dosimetrist (the person who will produce the computer plan for your treatment).

The scan will be taken with you lying in the same position as for your treatment. If you have had a mask made, you will be wearing it for the CT scan. The radiographers will put some stickers on the mask. They will be used as a reference for your treatment. You will then be scanned, which will only take a few minutes.

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

Having your treatment

When you arrive for your treatment you should go to the radiotherapy main 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.Treatment is usually given daily, Monday to Friday however your treatment may start on any day of the week. Whenever possible you will be treated at the time of day that suits you, but this cannot always be arranged or guaranteed.

There may be occasions when you may have a longer stay in the department or be asked to attend at a different time, for example to see your oncologist. Depending on the area that needs treatment, you may need to undress and put on a gown. The radiographers discuss this with you when you first attend the department.

The treatment marks and any individual protective shielding will be checked. If the treatment involves your eyelid, you may need to wear a protective contact shield during treatment. This will be inserted after a local anaesthetic to the eye (i.e. a couple of anaesthetic eye drops). Your eye will need to be covered for two hours after the treatment. Therefore, driving yourself to hospital should be avoided if you need to wear this type of eye shield.

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

Once you are in the correct position the radiographers will leave the room to switch on the machine. You will only be alone for a few moments at a time. 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 also an intercom system so the radiographers can talk to you.

The treatment only takes a few minutes but you will be in the treatment room for about 10-15 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 and help you off the couch.

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 signs in the waiting areas. 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. There is a restaurant and café available on Level 0.

Your treatments will generally be on the same machine, although there may be days when this machine is being serviced and your treatment will be in a different room.

Side-effects

Side-effects can be divided into short term (acute) effects that happen during or soon after treatment, and long term effects which occur months or years later. Some side-effects are common, whilst others are rare. The area and amount of treatment given to you will affect which side-effects are most likely to happen to you. 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.

Short term side-effects from radiotherapy

Most side-effects are common and are temporary. Side-effects tend to build up from about the second week of treatment and 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 around 10 days after starting your radiotherapy. It may become dry and itchy. Sometimes later in treatment it may peel and become weepy. If your nose is being treated you may experience crusting and soreness inside your nose.

Avoid hair removal where possible, including shaving, waxing, cream and lasers unless advised otherwise by your consultant, nurse or radiographer.

Before you start your treatment, a radiographer will explain what could happen to your skin and how to look after it. They will also give you a leaflet to take home.

Tiredness (fatigue)

Nearly all patients having radiotherapy will feel tired.

Be prepared to take things easy during treatment and allow for extra rests. There is a Macmillan information leaflet available and if you would like a copy, or support with your fatigue please ask a member of staff. Try to continue with some of your normal routines and activities if possible. If you usually work you may find this can help maintain your mood, but you may find it better to reduce your hours or take some time off.

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.

Hair loss

Only hair in the treated area will stop growing and may fall out. Your doctor will tell you if you might lose your hair. Sometimes hair will not grow back after treatment.

Possible long term side-effects from radiotherapy

Long term skin changes

Months after your radiotherapy treatment you will notice that the skin where you had the treatment appears paler and you might notice some fine blood vessels too. These changes can easily be covered up with make-up.

Other long term side-effects will depend on the exact details of your treatment. For example, if your nose is being treated a small number of patients may experience long term crusting or a blocked nose sensation.

If you are concerned about your risk of developing any long term side-effects please speak to your consultant or specialist nurse.

Cancers caused by the radiotherapy

When you have had radiotherapy there is a risk that cancer can develop many years later, however this is rare. If you have any concerns, please discuss this with your consultant.

Nutrition

It is important that you are well nourished and drink plenty of fluids during your treatment in order to keep you healthy and to help your body to heal.

How well you can eat and drink varies, depending upon where the cancer is and on the details of your treatment.

When radiotherapy has finished

Your side-effects may get worse in the first few weeks after treatment and will then gradually settle.

You may be asked to attend the hospital where you were first seen by your oncologist for follow-up checks at regular intervals. This will vary according to the area you have had treated. Please discuss this with your doctor if you have any concerns.

Research at Leeds Cancer Centre

Leeds 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, and 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 who 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.

Skin Cancer Clinical Nurse Specialists (CNS)

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

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

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 or accepting their diagnosis. 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 your treatment.

Local Support Services

Leeds Cancer Support

Leeds 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 Sir Robert Ogden Macmillan Centre (behind the Thackray Medical Museum).

The Sir Robert Ogden Macmillan Centre

This centre offers a variety of free health & wellbeing and supportive therapies for patients, their family members and carers. These include hypnotherapy, mindfulness coaching, acupuncture (for hot flushes) and pilates.

Contact numbers for Leeds Cancer Support

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.

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

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 a charge for relatives if they are staying in their own room.

There are no cooking facilities in the hotel.

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 no staff after 4pm until the next morning in this facility.

How to find us

St James’s University Hospital – site plan