The Cancer Directory. Dr. Daniel Rosy
or ask to see the consultant oncologist who has planned your treatment.
Different centres may use different machines, with larger centres having a wider choice for more specialized treatments. But it may be appropriate to be treated at a small centre nearer home to cut down on the hours spent travelling to and from the hospital each day. Once again, a relative-benefit evaluation needs to be done, involving both you and your doctor.
If the most important aspect of treatment is the cosmetic result, then this may necessitate a lengthier treatment using a relatively lower dose to avoid long-term skin damage from the radiation. However, if the final appearance is not of concern and the area being treated is very small, it may be possible to have a shorter course of radiotherapy using a higher dose. Radiotherapy treatment is flexible, and it is important that the patient makes his needs apparent at the outset so that the consultant can tailor the treatment appropriately.
New research by Professor Kedar N. Prasad in the US has shown that, far from potentially diminishing the effectiveness of chemo-and radiotherapy, high-dose vitamin and mineral therapy can potentiate both forms of treatment. This is because the abnormal tumour cells become more vulnerable after having taken up high levels of antioxidants (see Chapter 5).
Side-effects of Radiotherapy
A full description of remedies to reduce the side-effects of radiotherapy are found in Chapter 7.
Fatigue and Nausea
One side-effect that many people experience during their radiotherapy treatment is general fatigue and nausea. This is thought to be due to:
• your body having to work harder as cells are destroyed
• the toxicity of the radiation
• the disruption to your body’s natural energy fields.
So, you should not be at all surprised if you need an extra two or three hours of sleep every day, and spiritual healing to lift your energy and spirits. See Chapter 7 for ways to help your body cope with this treatment with the help of homoeopathic remedies and acupuncture, which releases the stored heat and energy radiotherapy causes.
Nausea may be experienced at the beginning of treatment, but this should gradually improve with time. This may occur especially when a large part of the body is being treated, and is particularly common during radiotherapy to the abdomen, although it may also arise when having treatment to nearby areas.
Skin Burns
With skin cancer, the area being treated is likely to be affected by the radiation, leaving your skin red and sore, rather like sunburn, towards the end of treatment. (Again, for information on helpful radiation cream, see Chapter 7.) Individuals vary in their sensitivity to radiation. The same dose may produce a severe skin reaction in one person and only a mild reaction in another. As a rule, symptoms are worse towards the end of treatment, often reaching a peak after four or five weeks.
Difficulties with Eating and Drinking
If treatment affects your oesophagus or throat, you may find it becomes rather inflamed and sore. This is because radiotherapy initially causes an inflammatory reaction. You may have difficulty swallowing, and find eating and drinking painful. Discuss this with your doctor to try and prevent this as much as possible, as this problem is unpleasant and can make you feel miserable. A nutritional advisor would be helpful at this time for advice on suitable food, drinks and remedies, and also to support you if the going gets tough. Again, see Chapter 7 for any complementary therapies that may help. You may also experience diarrhoea if the bowel is irradiated.
Possible Flare-up of Symptoms
Because the effect of radiotherapy builds up over weeks and because the tissues being irradiated become inflamed, your initial symptoms may temporarily get worse before they get better. For example, if the problem is a bony secondary tumour pressing on a nerve, then, for up to six weeks post-treatment, the pain or nerve impairment may get worse. But as the inflammation subsides, relief will be experienced.
Infertility
Radiotherapy to the reproductive organs may affect your ability to have children. Some effects are transient and return to normal after a while, whereas others are permanent. If you are considering having children in the future, check with your doctor about the possible risks, and find out what steps can be taken to aid fertility in the future. For example, men may wish to have sperm frozen for use later or, for women, egg collection and later IVF (in vitro fertilization) may be considered.
Limitations of Radiotherapy
Tumours are given a dose of radiotherapy that is close to the maximum tolerated by the normal tissues in the area being treated. The risk of damage to normal tissue is the major factor limiting the dose of radiotherapy given. There is also an overall limit to how much radiation can be given to one area or the whole body.
Should the tumour recur, further radiotherapy to the previously treated area may then exceed the normal tissue tolerance, so it is unusual to be able to repeat a course of treatment if there is a recurrence in the same place. Especially sensitive structures include the brain, spinal cord, lungs, liver and bone marrow, and great care is taken not to cause radiation damage in such areas.
It can be very frustrating for someone who responded well to radiotherapy the first time not to be able to have further radiotherapy for a tumour recurrence at the same site.
Radiotherapy, like surgery, is a form of local treatment. So if the tumour has spread beyond the confines of its primary site, radiotherapy cannot be considered a curative treatment.
Palliative Radiotherapy for Symptom Control
Radiotherapy is often used to control symptoms in a palliative setting. In general, palliative care is aimed at improving your comfort and quality of life. Palliative radiotherapy is given in short bursts or sometimes as only a single treatment.
Radiotherapy can be very effective for pain relief, especially of that caused by bone metastases. Studies have shown that single treatments for pain can be as effective for many symptoms as a long drawn-out course requiring many hospital visits. If you are in any doubt as to the usefulness of radiotherapy for your symptoms, ask the oncologist, the radiographers or a palliative care consultant.
Here is a checklist of questions for the radiotherapist:
• What is the treatment being offered?
• When will the treatment be planned?
• How long will this take?
• When will the treatment start?
• How many treatments will I have and how long will each one last?
• Can I drive myself to treatments and, if so, where can I park my car?
• Can I stay in hospital or in a hostel nearby during my treatment period?
• Can I choose the time I will be treated each day?
• Are there any days that I will not be treated?
• What are the immediate side-effects and what should I do about them?
• Will it affect my fertility?
• Is there anything I should avoid, such as sunbathing, swimming or washing?
• When will I next see a doctor?
• What happens when I finish the course of treatment?
• Is there any support available if I am frightened