Involved field radiotherapy for lymphoma

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Radiotherapy is a localised treatment and side effects depend on the area of your body receiving the X-rays. There are two types of side effects; those which come on during or immediately after treatment (acute side effects) and those which can be long term (late side effects). Your oncologists will have taken these into account when considering the benefits of treatment and will inform you of the side effects you are likely to get. Please discuss any concerns with your doctor, specialist nurse or radiographer at the time of consent or at any time during radiotherapy.

This information sheet provides a brief introduction to radiotherapy and explains the common side effects you may experience. This does not mean you will definitely get them. It is also possible you may experience a side effect not mentioned here.

Your first appointment at the radiotherapy centre will be a planning session in the simulator. Report to the reception desk, show them your card, and they will direct you. You will then be welcomed by a specialist radiographer, who are people who operate the machines to plan and give your treatment. Don't be embarrassed to ask them anything you are concerned about. During this first visit we plan and arrange your radiotherapy - you may not have a formal consultation with the doctor at this stage. Of course any urgent issues will be addressed but others should be saved for the regular consultations you will have during treatment. It is often difficult to judge exactly how long each patient will take - unfortunately it is possible you may wait a long time.

The simulator  is a machine which is a direct copy of a therapy machine. It takes X-rays pictures to enable the oncologist to decide the exact area of your body which needs treatment. While very accurate measurements are taken, you will have to lie on a fairly hard couch which may be slightly uncomfortable. A small tattoo about the size of a pin head is made on your body - giving a permanent record of the measurements.

The treatment machine looks similar to the simulator. You will not be required to do anything you haven't already done in the simulator. Although the radiographers are not in the room while you are being treated, you are being watched at all times on a video camera. If you feel any distress, the machine can be turned off and the radiographers will be at your side within seconds. There is also an intercom which is left on. Treatment usually lasts only 1 to 2 minutes. While the machine is on, you usually do not have any sensation. After treatment you will not be radioactive and are no risk to friends or family.

Additional information  the BACUP booklets "Understanding radiotherapy" and "Understanding Lymphoma" . A video called "Radiotherapy & chemotherapy" is also available from HEP 231a Cathedral Rd, Cardiff CF11 9PP, Tel:01222 40 30 22. The Lymphoma support group has a useful website.

Potential acute side effects

You may get tiredness, so adequate rest is important. As radiotherapy is a local treatment and other side effects depend on where your oncologist has determined to direct the therapy. The following side effects refer to treatment to the chest but check this with your nurse, doctor or radiographer or refer to the index of side effects to different sites of the body 

You will probably develop soreness on swallowing or a lump in your throat towards the end of your treatment. You will be given some white medicine (called mucaine) and some yellow liquid (called nystatin) in case this happens.

You may develop a cough towards the end of treatment and a month or two after. This almost always gets better on its own within a few weeks.

Your appetite may be affected. If you this effects you try to eat several small meals rather than three large meals a day. Drink lots of fluid - try to double your normal fluid intake. If you are worried about diet ask your radiographer to refer you to a dietician.

You may develop a feeling of nausea or sickness during treatment. Report any nausea or vomiting to your doctor as your symptoms can be relieved with anti-sickness tablets. For larger treatment areas you will be given an antisickness tablet to prevent nausea.

The skin in the treated area may become red and sore, especially in the skin creases. You can take a shower during your treatment but it is not advisable to sit and soak in a hot bath. Simple non-medicated soap should be used, i.e. baby soap, and the treated area should be dried by dabbing with a soft towel. Avoid sun or sunbeds in the treated area for at least a year and it is very important not to sunburn.- also see advise on skin care.

You will notice that you lose hair at the nape of the neck, under the arms, and possibly part of the beard and chest hair. This will regrow after treatment.

You may develop a tingling sensation down the back of the spine called when you bend you head forward this should settle within 3 to 6 months. This is called L'hermittes syndrome.
 

Potential late side effects

The radiotherapy treatment will damage the upper part of the lungs. This damage can be measured with special lung function tests but you are unlikely to develop a restriction in in exercise capability. To decrease your risk further it is very important not to smoke - see advise on quitting smoking.

Radiotherapy to the thyroid can cause a decrease in hormone production in the years following treatment. If this occurs you will be required to take daily thyroid replacement tablets. The doctors will check on this during your regular follow up appointments.

In the very long term there is a slight increase in the risk of heart problems because of the effect of radiation on the heart. This must be weighed against the risk of failing to treat Hodgkin's disease adequately at the outset. To decrease your risk further it is very important not to smoke - see advise on quitting smoking.

There is a slight increase in the risk of a second malignant disease especially the breast and lung. Again this is a rare event and depends your current age and amount of tissue included in the radiation field - ask if your worried. To decrease your risk further it is very important not to smoke - see advise on quitting smoking.

 


Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.


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