Iridium radiotherapy treatment (anus)

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What is Iridium ?

Iridium is a radioactive material, which is in the form of lengths of wire.  These will be placed into the area of treatment around the anus, so that the radiation is concentrated where the treatment is most needed.

To get the iridium in the correct position, an array of hollow needles is first put into place and then the wire is inserted into the needles.

The treatment can take from two to seven days, depending on the dose prescribed by the doctor.

What does the treatment involve ?

The room:
The room where you will be receiving your radiotherapy is on ward A5.  It has been specially designed for the treatment that you are going to have.  The doors have been lead lined for the safety of you and others.

Your room will contain a television, call bell and personal bathroom.

We do recommend that you bring books and magazines to read as you may feel isolated when your treatment commences.

Admission:
You will be admitted the day before the procedure.

When arriving on the ward, please report to the nurses station where you will be shown to your room.  A nurse will conduct an admission questionnaire to obtain information about you and your lifestyle and answer any questions you may want to ask.

Food and drinks are served throughout the day.  However; the nurses will be more than happy to make you additional drinks should you require.  Please use the call bell or internal telephone in your room.  Dial 2312 or 2312 to get through to the nurses station.

You will not be allowed to eat or drink from midnight on the day of the anaesthetic.

Pre-operative care:
If you have not been seen by the doctors in the pre admission clinic then you will be seen on the ward, where you will have bloods taken and maybe an X-ray or ECG performed, if required.

Operation day:
On the morning of the operation you will be assisted by a nurse to get ready for theatre. You will be taken to theatre on your bed.  A staff member will accompany you and introduce you to the theatre staff who will look after you until you go into the operating room.

In the operating theatre hollow needles are inserted into the treatment area under general anaesthetic.  These are attached to a plastic template, which sits outside the body and stitched to the skin to hold the needles in place.  While you are in theatre, you will have a catheter inserted to drain the bladder.  This will remain in place for the duration of the treatment, so that you do not need to use the toilet.

After the procedure has been completed you will be collected by a nurse from A5 who will bring you back to the ward and make sure that you are as comfortable as possible.  They will do some standard checks at this time.

The treatment can be uncomfortable and appropriate medication will be administered to relieve any discomfort if required.

You may eat and drink as you feel able.

Around midday, you will be taken to the radiotherapy department to have x-rays taken to check the positions of the needles.  Once the films have been taken you will return to the ward.

Commencement of treatment:
The radioactive wires will be inserted by the doctor either later that afternoon or on the following day.  Once the radioactive wires are in place, you will be kept in isolation in your own side room.  Visitors will be restricted and will have to follow some radiation safety guidelines whilst in the room (see section 3). 

Nursing staff will check on you and your treatment every four hours to make sure that the radioactive wires remain in the correct position and that you are comfortable.  If you yourself notice that any of the wires come loose or fall out, inform the nurses as soon as possible so that they can be put back into position.  DO NOT TOUCH OR PICK UP THE WIRES.  You may contact the nurses at any time using the call button and telephone.

You will be able to read, watch TV and eat and drink normally during the treatment.

On the second or third day you will be told exactly how long your treatment will last.  This cannot be known prior to starting the treatment, as it requires calculations using the x-ray pictures.

We do advise you to do deep breathing and foot and leg exercises to prevent the risk of complications whilst on bed rest.

Completion of treatment:
When the treatment is complete, a doctor will remove the catheter, the radioactive sources and the template with the needles. 

You may go home once the treatment has finished and you have passed urine normally.  You will NOT be radioactive and it is safe for you to be with family and friends.

Discharge:
Once treatment is complete a letter will be sent to your GP regarding the treatment you have received.  Any medication needed will be given to you and an outpatients appointment arranged and posted to your address at a later date.

Visitors

Because your treatment involves radioactive material, we request that a few simple radiation safety precautions should be taken during the time that the wires are in place.  If these simple rules are followed, the radiation does not pose a risk to visitors:

• visitors must report to the nurse in charge of the ward prior to entering the room and when they leave  

• the time spent by each visitor with you should not normally exceed thirty minutes per day  

• visitors must sit behind the lead shields provided in the room

• pregnant women and persons under 18 years of age must not enter the room

If there is any reason that your visitors will have difficulty complying with these rules, please ask to speak to the Radiation Protection Supervisor, who will be happy to discuss them with you.

Potential Side effects  

This is a localised form of radiotherapy and side effects therefore only related to the area that receives treatment. There are two types of side effects; those which come on during or immediately after treatment and resolve acute (early) effects and those which can be long term late (delayed) effects.- These can come on within weeks or even years after treatment  and are permanent. Your oncologists will have taken these into account when considering the benefits of treatment and will inform you of those 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. The more common side effects will now be described but this does not mean you will definitely get them and it is also possible you may experience a side effect not mentioned. 

•   Early side effects

The needles are painful and in a sensitive part of the body. Be prepared to be in some discomfort while they are in place.

During and after the insertion you will have a feeling of fullness in the back passage - like you have something in the rectum.  This is called tenesmus and may last several weeks

The tablets given to you to help the pain will also cause constipation. 

You can expect to have a sore skin reaction - this will develop within a few days of the insertion - it normally lasts 2-3 weeks but can be much longer if severe. The skin will look red and ulcerated.  Some creams will help but it is important not to rub the area.

There is a very small risk of developing a blood clot in the legs when lying in bed in hospital (thrombosis).  You will be given stockings to minimise this risk.

•   Late side effects  

The tenesmus (feeling of fullness) may rarely become permanent due to fibrosis.

The function of the anal sphincter may rarely be damaged causing lack of control of the motions.

The skin around the anus can develop prominent red blood vessels and become thinned this is call telangiectasia and indicates the skin is more fragile than elsewhere.

In women very rarely, if side effects are severe, a fistula (opening) could form between the rectum and the vagina. 

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.