Your oncologist has advised a course of radiotherapy as part of your treatment for cancer of the oesophagus (gullet).

This information has been written to help answer some of the questions you may have about the side effects of radiotherapy.

We hope you will find this helpful but if you have any further questions relating to your treatment, please do not hesitate to ask your radiographer, nurse or your oncologist.

Early side effects are temporary and affect most patients. The side effects generally develop during the second half of the course of treatment. Sometimes side effects can last for several weeks. However they usually settle within three to four months.

Effects on the skin

Towards the end of treatment some patients may experience changes in the skin over the area that has been treated. The skin may:

• feel tight and uncomfortable
• become pink or red
• become dry and flaky
• itch
• you may lose your hair in the treated area. This will usually re-grow a few months after treatment has finished.

Your skin reaction may be more noticeable and develop earlier if you are also having chemotherapy.

Your skin changes will be monitored by your radiographers during radiotherapy and you will be given advice on skincare.

Skin care – what can I do to help?

We recommend that you take special care of your skin during and up to six weeks after your radiotherapy as the reaction may continue after treatment has finished.

• Keep the area cool. Wear loose, preferably cotton clothing that does not rub the skin and will allow air to circulate.
• Do not expose the treated area to the sun.
• Whilst in the sun the treated area should be covered completely or a high protective factor sun cream (25 or above) should be applied. Do not use a sunbed as this could make the reaction worse.
• Do not soak the area in the bath or under a long hot shower. You may wash your skin in the treated area using a simple, unperfumed soap, applied gently with your hands and rinse well with warm water. Avoid using flannels or sponges. Pat the area dry with a soft towel or let the skin dry naturally.
• Do not use talcum powder, bubble baths, bath salts, shower gels or body lotions on the treated area as they tend to be highly perfumed and can dry or irritate the skin.
• You may be given a moisturising cream to soothe the skin, from the radiographers or nurses, or your oncologist may prescribe a cream if needed.

Tiredness or fatigue

Radiotherapy can sometimes make you feel very tired especially towards the end of your course of treatment and for a number of weeks after. It may be a while before you feel able to do some of your usual activities.

You should rest as much as you need to although gentle exercise may help. Fatigue is something nearly everyone with cancer feels. It affects people differently and it is important to tell the health care team if you are feeling more tired than usual. There are some physical causes, such as anaemia that are readily treatable.

Please ask for a booklet on "Fatigue" at the Information Centre in NCCT which will give you tips to help with this.

Swallowing and eating problems

Radiotherapy to your chest can cause internal inflammation and maymake it difficult or sore when you swallow. It can also feel as if there is a “lump” in your throat. Your oncologist may suggest increasing your painkillers.

You may feel nauseous (feeling sick) or you may have a feeling of indigestion or heartburn. Please tell your radiographer, nurse or oncologist as they may be able to offer you some medication to help and arrange an appointment for you to discuss dietary requirements with a dietician.

Your swallowing may get worse e.g. you may find that it is difficult swallowing liquids, food sticking at the back of the throat or drinks going down the wrong way. Tell your oncologist, radiographer or dietician if this is happening to you. They may wish to look at other ways to help you swallow more normally or arrange for you to see a speech and swallowing therapist.

You may not feel much like eating, but it is important to try.

Try these tips:

• if your throat is dry, it may help to drink more liquids. Carry a small bottle of water with you, to sip. It is important not to become dehydrated.
• eat little and often.
• eat a bit of what you fancy!
• try soft or runny foods such as milk puddings, pasteurised yoghurts, soft cheese and mashed foods. Don't eat jars of baby food - they aren't suitable for adults. Instead soups and meal replacements (e.g. Complan) are good.
• if you have a food processor, try puréed food.
• you can make soft food more nourishing by adding things like butter, cooked eggs, cream, sauces, gravy, mashed or minced meat or fish.
• eat tepid food and drinks
• avoid highly spiced foods
• if you're too tired to cook, try a ready- made meal, cold food or ask someone else to cook for you.
• if you are also having chemotherapy there may be some foods you should avoid. Your chemotherapy doctor or nurse will tell you more about this.

How else can I help myself during treatment?

• try not to smoke. It can make your side effects worse. Please ask if you need help with stopping smoking
• try to avoid alcohol as this will make you dehydrated
• tell us if you are worried about your side effects, if you feel unwell or if you have any problems or questions about your treatment.

Your progress

You will be seen by a member of your specialist team once a week during your treatment. This will be an opportunity to discuss any concerns or problems you may have.

Please tell your treatment radiographers if you have any problems between appointments.

The likelihood of these effects is small and varies from person to person. Your oncologist will have discussed these effects at the time of your consent to treatment therefore the following is a general guide.

• The area of the gullet that is treated may become narrowed and cause a change in your swallowing. It is important to tell your GP or oncologist about this. Often this narrowing is a result of scarring produced by the radiotherapy and this part of your gullet may need to be stretched. This may be done at your local hospital.
• You may experience some breathlessness or a cough about 6-12 weeks after your treatment is completed. This may be due to the radiotherapy, which can occasionally cause a temporary inflammatory reaction in your lung. This is called pneumonitis. It can be treated with steroids although it usually resolves itself over
  a period of a few weeks. Your oncologist will check this for you at a follow up appointment.

Your emotions

It is important to make time for yourself. Emotions associated with the reactions to a diagnosis of cancer may come to the surface at various stages during your treatment.

Don’t worry if you feel low, this is normal. If you need to talk to someone, please ask, we are here to help. We have a wide range of support services within the department, such as the palliative care team, dietician and social worker.

A Clinical Psychology service is also available at NCCT on referral from your oncologist.

Sex

Having radiotherapy for oesophageal cancer will have no long-term effect on your sex life. However when you are tired or have worries about your cancer, your sex drive can be affected. This is personal to each individual and may be an aspect of your life about which you have concerns. You may have questions you wish to ask. Please talk to your radiographer, oncologist or the nurse specialist if you would like to talk about these issues confidentially.

There is more information available in the Information Centre at NCCT.

Pregnancy

It is very important that women are not and do not become pregnant whilst undergoing radiotherapy. Please inform a member of staff immediately if you think you may be pregnant. You will be asked (if appropriate) to confirm that you are not pregnant by one of the radiographers before starting treatment.

Chemotherapy and Radiotherapy (chemo-radiation)

Some patients may have drug treatment (chemotherapy) at the same time as their radiotherapy. Some patients receive a couple of courses of chemotherapy before they begin any radiotherapy. Combining chemotherapy with radiotherapy may result in side effects being more noticeable and they may also last a little longer.

The side effects of radiotherapy can continue for several weeks after treatment has finished.
Continue with your skincare routine until any changes return to normal.

On your last treatment you will be given a discharge letter with a copy for your GP summarising any side effects you may have and any creams or medication you have been prescribed at NCCT.

You will be sent a follow up appointment to see your specialist team usually between 4-6 weeks after finishing treatment.

You will get a letter giving you a date and time for your appointment.

If you are worried about your side effects after your treatment has finished, please contact your specialist nurse at your referring hospital for further advice.

Useful contact telephone numbers:

NCCT Information Centre
Telephone:  (0191) 256 3596 or (0191) 256 3597
Monday to Friday from 10am to 4pm

CancerBACUP
Telephone:  020 7613 2121 / Freephone 0808 800 1234
CancerBACUP

Macmillan Cancer Relief
Tleephone:  020 7840 7840
Macmillan Cancer Relief