Radiotherapy to the Oesophagus

This page is information 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 other specialist health care professionals.

This 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.

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

Cancer of the oesophagus

The oesophagus (gullet) is the muscular tube that connects the back of the mouth with the stomach. It passes through the centre of the chest, behind the heart and between the lungs.

Cancerous growths that start along its length are known as ‘oesophageal cancer’.

What is radiotherapy?

Radiotherapy is the use of high energy X-rays to treat cancer. The radiotherapy causes damage to the 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 that is treated.

When 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 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 oesophagus is usually given over 1-4 weeks. This is a total of between 5-20 treatment days. Treatment is usually 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 and we will let you know if this is the case. The radiographers will be able to explain the details of your individual radiotherapy appointments. Your treatment is usually 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. They are highly trained in the accurate planning and delivery of radiotherapy treatment. You will see them at each treatment session. 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 about these issues.

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 the 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).

Your treatment position depends on which part of your oesophagus is to be treated. The following information explains the different positions we may use for your planning and treatment. Only one position will be used throughout your treatment.

If you need treatment to the upper part of your oesophagus you may need to have a plastic mask made (as shown in this picture). This will be made the same day as your scan. This helps in the accurate delivery of your radiotherapy treatment as it supports your head and neck so you can keep still.

The radiographers can draw treatment marks on your mask, instead of your skin, to position you for your treatment each day. 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 able to help you.

You do not need to wear a mask if you are having your middle or lower oesophagus treated. In this case you will have your scan and treatment lying flat with your arms above your head. You must be able to keep this position for about 15 minutes each day during your radiotherapy treatment.

If you are not comfortable and think you are unable to hold this position then please tell the radiographers at your planning scan. Please tell your doctor, preferably in advance, if you are unable to keep your arms up. In this case we may need to use a mask.

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, shown in the photograph above.

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 or 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.

You may need to have a dye injected into a vein in your arm or a 4D scan to monitor your breathing (see 4D scan section). This can help the doctor when planning your treatment.

The radiographer will explain about the type of scan you will need. The scan will be taken with you lying in the same position as for your treatment.

The radiographers will draw some marks onto your skin or mask, to be used as a reference for your treatment. You will then be scanned, which will only take a few minutes.

At the end of the scan the skin marks will be replaced by permanent marks (tattoos). 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 going to be a couple of weeks after the planning visit. The radiographers will talk to you about any further appointments you have.

4D Scan

This type of scan is only needed for tumours in the lower part of the oesophagus. You will be asked to drink some water, but only if you can manage this. A belt is placed around your stomach. The belt connects to the scanner and monitors how your tumour moves when you are breathing. This monitoring process can take about 30 minutes. However, the actual scan itself will take less than two minutes. If you need this type of scan your doctor will explain more about it when you are seen in clinic.

Contrast (dye)

A special contrast agent, often called a ‘dye’, may be used for your scan. It helps to make specific organs, blood vessels and/or tissue types appear clearer in the scan images. This can make it easier for the oncologist to plan your treatment. The dye is given through a very small plastic tube called a ‘cannula’ into a vein in your arm. You should tell the radiographer if you have any allergies. They will go over this before they use any dye.

Contrast side-effects

You may notice a warm feeling throughout your body and have a metallic taste in your mouth. You may also feel as if you have passed urine. This will pass very quickly. There is a slight risk of an allergic reaction to the injection, such as a skin rash. However, this very rarely leads to other complications.

The staff in the radiotherapy department are highly trained to manage any complications and again the risk involved is very small. You will be able to drive your car or go to work after your scan.

The radiographers will advise you about drinking plenty of fluids after your injection.

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.

You may need to partly undress and put on a gown, the radiographers discuss this with you when you first attend the department. The radiographers will position you, and adjust the treatment couch and machine to the correct positions. For the first few treatments and also intermittently during treatment we will also take images. This is to check the accuracy of the treatment, and will take a few more minutes.

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

You will have your treatment in the same position as your planning scan. Depending on the location of your cancer, you may be asked to drink water shortly before your treatment.

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.

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.

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

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 or a member of their team. 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. It may be a good idea to bring something to eat and drink with you. This includes 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 coordinators on your treatment unit.

For appointment queries please telephone the radiotherapy reception desk 0113 206 8940 for further advice.

Please ask your GP for further prescriptions for on-going medication after finishing your treatment.

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. The location 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

As your treatment progresses you may experience some side- effects. Not everyone will experience all of these reactions.

Most side-effects are common and are temporary. Side-effects tend to build up from about the second week of treatment and are usually worse after treatment has finished. They generally last a number of weeks or months after the treatment has finished.

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.

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. Fatigue usually improves in the weeks to months after treatment.

Things you can do to help yourself:

• Gentle exercise can help reduce the symptoms of fatigue.
• Having enough to drink can prevent tiredness caused by 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 and 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.

Pain and difficulty swallowing

Radiotherapy can cause inflammation, swelling and soreness of your oesophagus. This can result in discomfort, pain or difficulty when swallowing. If we are treating lower down the oesophagus it may feel like “heartburn” or “indigestion”. This can get gradually worse during treatment and can last for a few weeks afterwards. It is usually possible to control this discomfort with painkillers or by changing the types of food you eat. We can prescribe an antacid with local anaesthetic to ease this discomfort. Take it before meals and at bedtime.

If your swallowing becomes too uncomfortable or difficult you may not be able to get enough calories from food and supplements. If this happens you may benefit from being fed through a feeding tube.

If swallowing tablets becomes difficult during treatment, do not stop taking prescribed medication. Please contact your treatment team or clinical nurse specialist for advice.

Alternative formulations may be available.

Please read the information leaflet enclosed with any medications, this will explain any side-effects you may experience when taking them.

If you are at all concerned about any side-effects you are experiencing please talk to your pharmacist, nurse specialist or GP.

Skin reaction

In some patients, mainly those with tumours in the upper oesophagus, the skin in the treated area may redden or darken about 10 days after the start of radiotherapy treatment. However, this rarely happens with treatment lower down the oesophagus.

If it does occur, the skin may become dry and itchy. For a very small number of patients, 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 start 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. Alternatively, contact the review clinic nursing staff in the Princess Royal Suite, telephone: 0113 206 7587.

Cough

During treatment a small part of your lung, closest to the area being treated can get inflamed. This can occasionally cause a dry cough or increased shortness of breath. This is uncommon and is rarely serious enough to need treatment.

Sickness (nausea) and loss of appetite

If you feel sick during your radiotherapy please tell the radiographers treating you. It is usually possible to control this with medication. You may feel less hungry.

The combination of nausea, poor appetite and swallowing problems can make it difficult for you to eat and drink enough during treatment.

We will want to monitor this carefully. This will usually involve checking your weight and may require help from the dietitians. If you are struggling with any of these symptoms, then please tell us. You may need to come into hospital for further care.

Drinking regularly ‘little and often’ is a good way to make sure your body has enough fluid.

Long term effects

• The most common long term side-effect of radiotherapy is scarring and narrowing of the treated part of your oesophagus. Swallowing may be difficult or painful. There is a procedure to stretch the scarring which can be arranged if this develops.
• Late effects on the lungs can cause a cough or shortness of breath but this is very unusual.
• The spinal cord is the large bundle of nerves which passes down the spine from the brain and carries signals to your body and limbs. Radiotherapy is planned very carefully to avoid an excessive dose to your spinal cord. Damage to the spinal cord can be serious but is therefore very rare.
• The long term effects of radiotherapy on the heart are not fully understood. In long-term survivors of treatment the rate of heart attacks and heart failure will be slightly higher than the general population. However, accurate figures are not available.
• The rate of second or new cancers caused by treatment may be slightly increased in long-term survivors. Again, accurate data on this is not available.
• Radiotherapy may affect the function of an organ called the spleen, which helps your body fight infections. If this is relevant to you, your doctor will discuss this further with you and may recommend vaccinations and antibiotics.

These effects need to be balanced against the aggressive behaviour of most oesophageal cancers if treatment is not given.

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. This will vary according to the area you have had treated. Please discuss this with your doctor if you have any concerns.

Planning a return to work

If you find that you are tired after your treatment has ended you may consider taking a break from work or working part- time. It can be useful to talk to your employer about returning to work gradually, i.e. shorter or fewer days at first. Your GP can recommend this on your fitness to work note. There are Macmillan booklets available which offer help and advice on all areas of work during your cancer treatment.

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 a clinical study. 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.

Hospital contact number

Most queries during treatment can be addressed to the radiographers on your machine. If needed, they will contact the medical team on your behalf.

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)

CNSs are available to discuss any aspect of your treatment with you. They can 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. You should be given a ‘key worker’ as a contact for support through your treatment; this is usually your 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 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

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 Leeds 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, Leeds LS9 7BE

Email: [email protected]

Website: www.maggies.org

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 one 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, and 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