Radiotherapy

Written by: 
Suzi Lewis-Barned, medical writer

This guide to radiotherapy will outline what it is and why it's used as well as break some myths about it and offer practical help to anyone preparing to undergo it.

Radiotherapy - also known as radiation therapy, high-energy X-rayA type of electromagnetic radiation used to produce images of the body. therapy and irradiation - is used to treat many types of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. It works by using radiation to destroy cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells and shrink tumours.1-3

About half of all people being treated for cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. receive radiotherapy. For cancers diagnosed early - such as cancers of the skin, cervixAny neck-like structure; most commonly refers to the neck of the uterus. and prostate A gland that surrounds the urethra near the bladder. It produces a fluid that forms part of the semen. - radiotherapy may be the only treatment used, but it can be combined with chemotherapyThe use of chemical substances to treat disease, particularly cancer. or surgery.1,5,6

Radiotherapy may be used to treat almost every type of solid tumour in almost every part of the body. It can also be used to treat leukaemiaA malignant condition in which increased numbers of white blood cells, leucocytes, are produced in an immature or abnormal state. and lymphomaA type of cancer that affects the lymph nodes, part of the immune system. (cancers of the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid.-forming cells and lymphatic systemVessels that carry lymphatic fluid, a fluid derived from the blood.).

Radiotherapy may also be used at different times and for different purposes as follows:

  • Sometimes radiotherapy is used to shrink the size of tumours before surgery. This is known as neo-adjuvant treatment.
  • Intraoperative radiation therapy (IORT) may be given during surgery to treat localised cancers that cannot be completely removed, or that have a high risk of coming back in nearby tissues. The technique may be used when treating cancers of the thyroid, small intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. or pancreas, colorectal cancers and gynaecological cancers. It is also being used in clinical trials to treat some types of brain tumour and pelvicRelating to the pelvis. sarcomaCancer of the connective tissues. in adults.
  • Radiotherapy may be used after surgery to ensure that all the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells are destroyed. This is known as adjuvant treatment.
  • When treating some types of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., radiotherapy may be used on non-cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. areas to prevent cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells from growing in the area receiving the radiation. This technique is called prophylactic radiation therapy.
  • Total body irradiation (TBI) is sometimes given to patients who require a bone marrowTissue within the bones where blood cells are formed. (or bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. stem cellThe basic unit of all living organisms.) transplant. As the name suggests, radiation is given to the whole body. This destroys existing bone marrowTissue within the bones where blood cells are formed. cells and patients are given new bone marrowTissue within the bones where blood cells are formed. transplanted from a donor, or removed from the patient before the treatment.

On this page you can find out more about:

Types of radiotherapy

There are two main types of radiotherapy, although there are currently many innovations in radiotherapy that are improving treatment and survival rates.

  • External beam radiotherapy uses a machine positioned close to the body. It may be used to treat most types of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. and can also be used to relieve pain if cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. spreads to other parts of the body from the primary site
  • Internal radiotherapy or brachytherapyA type of radiotherapy where radioactive pellets or wires are inserted into the tumour. is where an implant, a sealed source of radiation, is placed very close to or inside the tumour. This is sometimes used in conjunction with external radiotherapy.

In addition to these two treatments, systemic radiation therapy is sometimes used to treat cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. of the thyroid or adult non-Hodgkin lymphomaA type of cancer that affects the lymph nodes, part of the immune system.. This treatment uses radioactive materials that are taken by patients either orally or by injection. These are circulated around the body in the bloodstream.

Radiotherapy itself does not hurt and the radiation you receive is not hot - you feel just the same as if you were having an ordinary X-rayA type of electromagnetic radiation used to produce images of the body.. Nor does radiotherapy make you radioactive, although with brachytherapyA type of radiotherapy where radioactive pellets or wires are inserted into the tumour. the radiation implants temporarily send some radiation outside the body

Innovations in radiotherapy

Some recent developments in radiotherapy include:

  • Stereotactic radiosurgery - this is a new type of treatment that uses converging beams of radiation to deliver a very precise single dose of radiotherapy. It is also known as gamma-ray knife surgery - although it is not a traditional cutting surgical procedure. Originally only able to treat selected malignantDescribes a tumour resulting from uncontrolled cell division that can invade other tissues and may spread to distant parts of the body. or benign tumours and lesions of the brain or spine, the most recent development using a robotic radiosurgery system can also treat cancers of the prostate, lung, spine, liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats., pancreas and kidney. Find out more about robotic surgery
  • Intensity-modulated radiotherapy The treatment of disease using radiation.(IMRT) - allows the doctor to deliver targeted, variable radiation therapy to match the shape of the tumour.
  • Conformal proton beam radiotherapy, intensity-modulated proton beam radiotherapy or spot-scanned proton therapy - these treatments use proton beams instead of X-rays. Proton beam therapy is used to treat cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. of the eye and is being tested for other types of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. Early research indicates the treatment works well, with few side effects.
  • Ion beam therapy works on the same principle but uses carbon ions rather than protons. Carbon ions release more energy than protons.

These advanced radiotherapy treatments are not available in every hospital or clinic, however.4

How does radiotherapy work?

Radiotherapy works by damaging the geneticRelating to the genes, the basic units of genetic material. material that would otherwise enable cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. cells to grow and divide. The radiation does, however, damage both cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. cells and normal healthy cells, although most normal cells recover from the effects of the radiation.

Your medical team will use radiotherapy in a way that minimises the damage to healthy cells and directs the treatment very accurately at the tumour. To discover the exact position of the tumour your medical team will use diagnostic equipment such as:

  • A CTA scan that generates a series of cross-sectional X-ray images. (computed tomography) scanner - this can detect tumours the size of a grain of rice
  • An MRIAn abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field. scanner - this is used for cross-sectional views of the body
  • Ultrasound - this uses ultra high-frequency sound waves to diagnose cancers of the liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats., pancreas, kidneys, ovaries, prostate and breast.

Find out more about CT and MRI scans.

How long and how frequent are radiotherapy sessions?

Each session of radiotherapy lasts 15-20 minutes, although the machine will only be used for a maximum of 5 minutes each time.

Much of the time may be spent helping you to get into the right position, during which you will have to keep very still. During your session your care will be overseen by a small team of professionals.

A course of radiotherapy might last 8 weeks, although it is usually shorter. The duration will depend on:

  • The type of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • Whether the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. has spread
  • The type of radiotherapy you are receiving
  • The severity of any after-effects
  • The success of your treatment.5,7

How can I prepare for radiotherapy treatment?

Your medical team will be able to advise you about this. For many people the best preparation is to know what to expect and how your body might react to the treatment.

During your initial consultations it is worth taking the opportunity to ask plenty of questions - the better informed you are, the better prepared you are likely to feel.

There may also be local or national organisations that can offer help and support during and after your treatment. Your medical team should be able to suggest some useful contacts.

After-effects of radiotherapy treatment

People experience radiotherapy in different ways and it is a good idea to discuss with your medical team how any after-effects can be minimised.

It is important not to use any medicines, home remedies or creams that may claim to relieve your symptoms without first consulting your doctor.

After-effects occur at different times and vary from person to person. Some are experienced during treatment, some soon after treatment has ended and others some time later.

They can be both physical and emotional and may include:

  • Tiredness (this may sometimes be due to anaemiaA reduced level of haemoglobin, which carries oxygen in the blood. Anaemia causes tiredness, breathlessness and abnormally pale skin.)
  • Anxiety
  • Sickness and diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid.
  • Joint and muscleTissue made up of cells that can contract to bring about movement. stiffness
  • A dry mouth and difficulties swallowing (if you have been receiving head and neck radiotherapy)
  • A hoarse voice
  • A loss of taste, appetite and weight (if you have been receiving head and neck radiotherapy)
  • Sore and red skin that appears sunburnt
  • Shortness of breath and coughing
  • Hair loss, but only in the area treated.

Longer-term after-effects may include:

  • Tiredness
  • Fibrosis or scarring of the skin in the treatment area
  • The scarring of other tissues that then stretch less (for example of your bladderThe organ that stores urine., which may then hold less urine)
  • Darkening of the skin and/or tiny red marks on the skin from broken bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessels
  • Hair loss or hair growing back a different texture and colour
  • Swelling of the arms and legs due to the blockage of lymph vessels (lymphoedoema)
  • Shortness of breath (if you have had radiotherapy to your chest)
  • Infertility if your ovaries or testicles have been treated.4,5

How you might feel

People experience radiotherapy in different ways. Some people look towards the end of treatment with a sense of relief and excitement, but it is not unusual to feel any of the following:

  • A sense of anger
  • Uncertainty about the future
  • A loss of interest in things that had meant a great deal to you before your treatment.

If you feel worried, anxious or stressed for much of the time you should see your doctor, who will be able to offer help and advice.

What helps you cope with a radiotherapy course and deal with its after-effects?

Some or all of the following may help you cope with your course of radiotherapy and its after-effects:

  • A healthy diet
  • Drinking plenty of water (and avoiding alcohol, especially spirits)
  • Rest
  • Not smoking
  • Keeping to all your appointments
  • Following all the advice offered by your medical team
  • Using contraceptionA means of preventing pregnancy. throughout the course of radiotherapy or abstaining from sex during radiotherapy and for at least three months thereafter if pregnancy is a possibility
  • Keeping all treated areas out of the sun
  • Protecting the area of skin that has had radiotherapy.3,8,9

Women are often advised not to use deodorants during adjuvant breast radiotherapy, but the benefits of this are unproven and many continue to use them with few if any ill-effects.10

Getting emotional support

Talking about how you feel with family and friends and asking them for help may not always be easy, but it can help you to manage your emotions and get through some of the more difficult times.11

There may be a local support group where you can share your experiences with others, and your doctor may also be able to recommend a counsellor who can help you come to terms with your feelings and plan your future.

References: 
  1. 'Radiation therapy for cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.: questions and answers.' US National Institutes of health - National Cancer Institute. Link (accessed 11 July 2009)
  2. 'About radiology and oncology.' The Royal College of Radiologists. Link (accessed 11 July 2009)
  3. The Cancer Council, Victoria. Leaflet 'Coping with radiotherapy.' Link (accessed 11 July 2009)
  4. 'Radiotherapy research.' Cancer Research UK. Link (accessed 11 July 2009)
  5. 'Radiotherapy.' Bupa. Link (accessed 11 July 2009)
  6. 'Why radiotherapy is used.' Cancer Research UK. Link (accessed 11 July 2009)
  7. 'Radiotherapy: How long will each session last?' National Health Service Greater Manchester and Cheshire Cancer Network. Link (accessed 11 July 2009)
  8. 'Radiotherapy.' National Health Service Greater Manchester and Cheshire Cancer Network. Link (accessed 11 July 2009)
  9. 'Head and neck radiotherapy side effects: weight loss.' Cancer Research UK. Link
  10. Graham PH, Graham JL. 'Use of deodorants during adjuvant breast ratiotherapy: A survey of compliance with standard advice, impact on patients and a literature review on safety.' JMIRO. 2009; 53(6): 569-73.
  11. The Lance Armstrong Foundation. Now I Live Strong, The Survivorship Notebook. 2004