Short course radiotherapy to the head and neck

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 therapeutic radiographers and clinical nurse specialists but may also include speech and language therapists and dietitians.

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 have any questions after reading this leaflet, please speak to the team looking after you or ring the numbers at the end of leaflet. 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.

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 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 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 can vary from one to several treatments.

Sometimes, a five day course of treatment is prescribed. This is followed by a two week break before having another course of five days treatment (often called ‘split course radiotherapy’). Your doctor will explain the schedule they think is best for you.

Treatment is usually given daily, Monday to Friday, and may start on any day of the week. It is important to attend all of the treatment sessions. If you feel that you are unable to attend for any reason, please telephone us as soon as possible so that we can discuss this with you.

Do I need to stay in hospital for treatment?

Your treatment is usually given as an outpatient. If your symptoms or side-effects are causing you problems, your doctor or specialist nurse may suggest a stay in hospital.

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 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.

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 (this includes any painkillers you have been asked to take).
• 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. You will need to stay very still while you are having treatment. A mask, as shown here in the photo, will help you to stay still. Masks are made in the Mould Room and you will be given an appointment for this. You will wear your mask for your planning scan and treatments. If you have any concerns about the mask, please let your clinical oncologist or a member of their team know. We also have a support team who can help you.

They can be contacted Mon-Fri 9am – 5pm on 0113 206 7616, or you can email [email protected].

There is also a leaflet called ‘Having a radiotherapy mask made’.

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 (please see next 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 may include therapeutic radiographers, a mould room technician and a dosimetrist (the person who will produce the computer plan for your treatment).

Planning scans are not diagnostic examinations so you will not receive the results of the scan.

The scan will be taken with you lying in the same position as for your treatment. The radiographers will draw some marks on the mask and your skin, 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 mark will be replaced by a single small permanent mark (tattoo) further down on the front of your chest.

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 two weeks or less after the planning visit.

The radiographers will talk to you about any further appointments you have.

Having your radiotherapy

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 and 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 attend. The mask that you had made in the Mould Room and wore during your planning CT scan will be ready for you on your treatment machine. The radiographers will fit this and position you in it on the treatment couch.

They will also adjust the treatment couch and machine to the correct positions. For the first few treatments and sometimes during the rest of treatment the radiographers will also take images. This is to check the accuracy of the treatment. This will 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. 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. The radiographers may need to come in and out part way through each treatment.

After the treatment is complete the radiographers will come back into the room and help you off the couch. 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 also be occasions when you 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.

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. This includes any supplement drinks and/or medication (e.g. painkillers) you have been asked to take. There is a restaurant and café available on Level 0.

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 telephone the radiotherapy reception desk 0113 206 8940 for further advice.

Side-effects

Most side-effects are common and are temporary. 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 medical team.

Skin reaction

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 could 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 in the Princess Royal Suite, 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.

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 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.

Sore throat and throat ulcers

This can make swallowing difficult. 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 palliative nurse specialist, your consultant’s team or your GP.

Dry mouth

It helps if you take small sips of water regularly. If the salivary glands are in the area that’s being treated, dryness of your mouth can be long lasting.

Sticky, thick saliva or phlegm

You may produce more or thicker phlegm which can be uncomfortable and make you want to cough. We may suggest using a nebuliser to help; the radiotherapy nurses will give you advice. Drinking soda water can help loosen the secretions.

Loss of taste

Foods may start tasting the same with some types of treatment. Some patients describe food tasting ‘like cardboard’. Your sense of taste will generally improve after radiotherapy. We can give you extra advice about coping with taste changes.

Chest infection

This can happen if food or liquid goes down the wrong way. It is important to tell the medical team if you are coughing or spluttering after swallowing. It may mean that food or liquid is going into your lungs rather than your stomach.

Nausea (feeling sick)

If you feel sick (nauseous) during treatment we can prescribe medication to help ease this. Please let a member of your medical team know if you feel sick or have been sick.

Constipation

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

Speech and voice

You may notice parts of your mouth and throat feel swollen and sore. This can sometimes affect the quality of your speech; you may sound a little unclear and people might have more difficulty understanding you. This swelling can also cause your voice to sound hoarse, husky or go completely. When you have finished your radiotherapy and the side-effects settle, your speech and voice will usually return to normal.

Mouth care and radiotherapy

Your mouth may become sore during your radiotherapy. Good mouth care helps to keep your mouth clean and comfortable.

These are some tips for looking after your mouth during and after radiotherapy.

During and shortly after radiotherapy:

• Clean your teeth and gums as thoroughly as you can morning and night. You can clean after meals if necessary using a very soft ’baby’ toothbrush.
• If you have your own teeth, use fluoride toothpaste to help protect your teeth from decay.
• If you have dentures you may wish to leave them out if your mouth is sore. Clean your dentures thoroughly after use with a suitable brush. Leave them to soak in a fresh solution of Dentural or Steradent.
• Use salt water (saline) mouthwashes every four hours during the day and after every meal. We will give you a saline mouthwash at the hospital. Use this mouthwash to swill around your mouth and spit out. If you have dentures (false teeth) you can use a pink foam stick to dip into the saline. Rub the stick around your gums, swill the saline around your mouth and then spit it out. If your mouth becomes sore it may help to use the saline mouthwashes hourly.
• The medical team may recommend other mouthwashes to use after the saline to protect the lining of your mouth. Do not use any mouthwashes bought from the chemist or supermarkets.
• Keep your mouth moist with sips of water. Try chewing gum or sucking sweets.
• Let us know if you notice any white or yellow patches in your mouth. These can be due to a thrush infection. If this is the case, anti-fungal medication will be prescribed.
• Avoid acidic drinks e.g. fruit juice and foods that make your mouth sting.
• Do not drink alcohol as this will make your mouth sorer.

Speech and swallowing during radiotherapy

Some swallowing difficulties may be mild and can be managed easily. Here are a few simple changes you can make to what and how you eat and drink:

• Make sure you take any medication given to you by the doctor. If you are still experiencing some pain or discomfort please tell the radiographers or nurses as soon as possible.
• Make sure you drink plenty of water throughout your treatment, to stop your mouth becoming too dry.
• Eat a soft and moist diet rather than dry, hard or crumbly foods. Use lots of sauces and gravy to help the food go down.
• Avoid distractions when eating and drinking. Turn off the television and do not talk when chewing and swallowing.
• Take your time when eating. Do not rush.
• Do not throw your head back when having a drink. Keep your chin down.

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.

Clinical Nurse Specialists (CNS)

Your local CNS (also called ‘key worker’), whom you may have already met in your main local clinic, is available to discuss any aspect of your treatment with you. 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 will 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. 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.

Open Monday to Friday 9.00am – 5.00pm
Tel: (0113) 457 8364

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

Macmillan Cancer Support

Freephone 0808 808 0000, 8am to 8pm seven days a week.
A textphone service for deaf and hard of hearing people is available on: 18001 0808 808 0000

Website: www.macmillan.org.uk

Changing Faces

A national charity committed to providing help for people with disfigurements. For support, information and advice:

Tel: 0300 012 0275
Website: www.changingfaces.org.uk

Mouth Cancer Foundation

A UK charity aiming to support people with mouth, throat and other head and neck cancer.

Tel: 01924 950 950
Website: www.mouthcancerfoundation.org

Alcoholics Anonymous

Tel: 0800 9177 650
Email: [email protected]
Website: www.alcoholics-anonymous.org.uk

Stopping smoking

NHS Smokefree Service Helpline: 0300 123 1044 Monday to Friday 9am to 8pm, Saturday and Sunday 11am to 4pm.
Website: www.nhs.uk/smokefree

OUTpatients

A cancer support and advocacy charity for the LGBTIQ+ community.

Email: [email protected]
Website: https://outpatients.org.uk

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.

How to find us

St James’s University Hospital – site plan