Radiotherapy

Radiotherapy uses high-energy rays called radiation to treat cancer. It destroys cancer cells in the area where the radiotherapy is given.

Some normal cells in the area being treated can also be damaged by radiotherapy. This can cause side effects. These normal cells are usually able to repair themselves, but cancer cells cannot. As the normal cells recover, the side effects usually get better.

Radiotherapy is always carefully planned by a team of experts. Radiotherapy treatment is continuing to become even more accurate. This allows your team to treat the cancer more effectively, while doing as little harm as possible to normal cells.

Chemoradiation is when you have chemotherapy at the same time as radiotherapy.

The chemotherapy makes the cancer cells more sensitive to radiotherapy. This can help make the radiotherapy work better. This is only used for certain types of cancer, so it is not suitable for everyone. Your cancer doctor or specialist nurse will explain what your course of chemoradiation involves.

If you have chemoradiation, your side effects may be worse than they would be if you were having just one treatment type. Your cancer doctor, nurse or radiographer will tell you how to manage and treat any side effects.

You usually have radiotherapy in a hospital that has a major cancer treatment centre. This means you may have some treatment at your local hospital. But you may have radiotherapy at a different hospital.

There are 2 ways of having radiotherapy:

• External beam radiotherapy  is given from outside the body (externally) using a radiotherapy machine.
• Internal radiotherapy is when a radioactive material is placed inside the body. It is called brachytherapy or radioisotope therapy.

How you have radiotherapy will depend on where the cancer is in the body and the type of cancer. Some cancers are treated with both external and internal radiotherapy.

Radiotherapy treatment is planned carefully for each person. This means that even if you know someone with the same type of cancer as you, their radiotherapy treatment may be different.

For most types of radiotherapy to your brain, head or neck area, you wear a radiotherapy mask during each treatment. The mask helps keep you in position so your treatment is as accurate as possible.

Your first planning visit usually takes 30 to 60 minutes, although it may take longer. Planning your treatment may take more than one visit.

Planning usually involves:

Your radiotherapy team will tell you what to expect. They will also tell you if there is anything you need to do to prepare for the appointment and your treatment. For example, before starting radiotherapy you may be asked to follow a special diet. Or you may be asked to drink plenty of water before each treatment.

It is important that you feel involved in your treatment. So, ask as many questions as you need to.

Questions to ask about your radiotherapy

It is important to understand your treatment and the effects it may have on you. Your healthcare team will be able to answer your questions. It can help to write down your questions.

You may be able to take a family member or friend with you to appointments. They can take notes about what is said. You can also ask permission to record the conversation. Then you can listen to it again when you get home.

You might want to ask some of these questions:

• What type of radiotherapy will I have? Does it have any other names?
• Why am I having this type of radiotherapy?
• What are the aims of the treatment?
• What hospital will I have my treatments in? Will I need to travel?
• How long will my course of treatment take?
• How often will I need to have treatment?
• What are the likely side effects of the treatment?
• Could there be any serious, long-term or late effects of the treatment?
• Are there other types of radiotherapy I could have?
• Are there any other treatments I could have instead of radiotherapy?
• How will the treatment affect my life? Will it affect my daily activities, work, sex life or fertility?
• Will I have follow-up appointments? If so, how often and who will they be with?
• Who should I contact if I need more information or have questions about my treatment?

Before your scan, the radiographer may ask you to:

• change into a hospital gown
• remove any jewellery or objects containing metal from your body
• have either a full or empty bladder.

You will usually have a CT scan of the area to be treated. This helps plan the precise area for your radiotherapy. Some people may have an MRI scan or a PET scan. If you have a mould or mask, it will be carefully fitted to help you lie still during your scan.

It is important to tell the radiographers if you feel uncomfortable so they can make you more comfortable. The radiographers record the details of your position. You need to be able to lie in the same position for all your radiotherapy treatments.

The information from the scan is sent to a planning computer. Your radiotherapy team use this to work out the precise dose and area of your treatment.

You may have markings made on your skin to help the radiographers position you for treatment.

Usually, tiny permanent markings are made in the same way as a tattoo. The marks are the size of a pinpoint and are only made with your permission. It can be a little uncomfortable while they are being made, but it makes sure that the treatment is directed accurately. If you have a mould or mask, the marks may be made on this.

These marks will only be made with your permission. If you are worried about them or already have a tattoo in the treatment area, tell your radiographer. They can discuss this with you.

After radiotherapy treatment there may be a risk you will have side effects that:

• do not get better after treatment – these are called long-term side effects
• only start months or years later – these are called late effects. 

This risk may be higher if you are also having other treatments, such as chemotherapy.

Before you decide to have cancer treatment, your team will explain your risk of developing these side effects. Even if it is not very likely, it is important that you understand and think about these long-term risks.

You can find more about possible long-term effects of radiotherapy in our information about the type of cancer you have. We also have information about the:

• late effects of bowel cancer treatment
• late effects of breast cancer treatment
• late effects of pelvic radiotherapy.

Radiotherapy to most areas of the body does not affect your ability to get pregnant or make someone pregnant. This is called your fertility.

But your fertility may be affected if you have treatment to:

• the pelvic area – the area between the hips in the lower part of the tummy
• the pituitary gland – a small gland at the base of the brain.

Before you decide to have treatment, your team will explain any risks to your fertility. For some people, radiotherapy causes changes that get better with time. For others, the treatment they have to the pelvic area or pituitary gland causes permanent infertility. 

We have more information about radiotherapy and fertility on our side effects of radiotherapy page.

You may have mixed emotions when you get to the end of your radiotherapy treatment. You will probably feel relieved, but you may also feel anxious and uncertain. Some people find they feel low after finishing the treatment. It can take time to rebuild your confidence and accept what you have been through.

It may also take time to recover from treatment. You may feel tired for a while and might have emotional changes or side effects to deal with. It is important to give yourself time to recover and adjust.

Complementary therapies may help you feel better and reduce any stress and anxiety. Not all complementary therapies are suitable for people having, or who have just finished having, radiotherapy. It is important to check with your cancer doctor first if you are thinking of having one.

When your treatment is over, you may want to think about making some changes to your lifestyle.

It is important to remember that support is available to help you with any physical or emotional problems you have.