Radiotherapy & Brachytherapy
How does it work?
Radiotherapy uses ionising radiation to kill cancer cells. The majority of people will have this treatment at some stage during the cancer journey either in a radical (curative) or palliative setting. Radiotherapy damages DNA and prevents normal functions like dividing and growth. Damaged cells cannot divide or function normally. Cancer cells find it more difficult to repair radiation damage than normal cells.
Radiotherapy is usually given on an out patient basis. An area of the body is mapped to receive a dose of radiation, which is carefully planned and calibrated to maximise damage to tumour cells and minimise damage to normal tissue.
Radiotherapy is given using a machine, which looks like an x-ray machine. Radiotherapy is a complex process with radiation being given from several different directions and targeted accurately at the cancer. Small tattoos (dots) may be used to ensure a person is positioned correctly on each occasion to receive a dose of radiotherapy. Sometimes special moulds are made to wear during treatment to help someone stay still during each treatment.
Brachytherapy
This treatment also uses ionising radiation but the radiation source is inserted into the tissue to be treated instead of being beamed in from outside. It is sometimes called internal radiotherapy. The radioactive source is contained inside capsules or rods and irradiates the tumour directly. It may be used in combination with external radiotherapy or chemotherapy or by itself.
Short term disabling effects of radiotherapy
Tiredness is a common side effect of radiotherapy treatment anywhere on the body. Other side effects are determined by the areas within the radiation zone. For instance radiotherapy for an oesophageal cancer will cause discomfort and pain on swallowing after a few weeks of treatment.
Areas of skin exposed to radiotherapy may become very sore, red and dry and any hair present will fall out, this usually grows back once treatment has finished.
Long term disabling effects of radiotherapy
The aim of cancer treatment is to cure cancer and return a person to full health with no disabling effects. This is often possible but with more people surviving for longer after effective cancer treatment, long term side effects are being studied in more detail. Long term side effects arise from the effects of toxic treatment on normal tissues.
There are two groups of long term problems after radiotherapy these are -:
- The development of second malignancies in the treated area - e.g. development of breast and lung cancer in long term survivors of Hodgkin’s disease following radiotherapy to the chest. Leukaemia is more common in people who have had this treatment.
- Effects due to long term damage of normal tissue
Internal effects may include thinning and stiffness of normal internal tissue such as blood vessels, this may lead to angina if the heart is affected. If the bowel is affected, chronic diarrhoea or abdominal pain is a common symptom and faecal incontinence due to urgency may be difficult to manage. This condition is called radiation colitis and used to be common after radiation treatment for cervical, endometrial and ovarian cancer. If the bladder is affected, urinary frequency and urgency are common problems.
External visible effects on the skin may include pigmentation or visible blood vessels (telangiectasia) in the area treated. Rare tumours called sarcomas may develop many years after radiotherapy treatment.
Care and Mobility needs during and after Radiotherapy
There are unlikely to be any care and mobility needs from radiotherapy treatment alone. The treatment generally only lasts for a few weeks to a few months. The side effects resolve once the treatment has finished. Long term side effects tend to arise some years later and may not be obviously linked to the radiotherapy treatment. If there are care and mobility needs during treatment they are more likely to be related to:
- Other pre-existing disabilities.
- Other treatment being received at the same time.
- The disabling effects of the disease itself.
- Care and mobility needs may arise due to the long term side effects of radiotherapy as previously described.
