Radiotherapy to the Colon, Rectum and Anus

  • Reference Number: HEY-304/2016
  • Departments: Radiotherapy

Introduction

This leaflet has been produced to give you general information about radiotherapy treatment to the colon, rectum and anus (bowels and back passage) in addition to the information you will receive from your clinical oncologist. Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and your doctor but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

The colon (large intestine), rectum and anus form what is sometimes referred to as the lower gastro-intestinal tract (or GI tract), or the bowels and back passage. The diagram below shows the lower digestive tract.

lowerDigestiveTract

What is radiotherapy?

Radiotherapy is the use of high energy X-rays and other types of radiation (e.g. electrons) to treat cancer.  Radiotherapy works by causing chemical and physical damage to the cancer cells in the treatment area.  Although some normal healthy cells are also affected during radiotherapy, these are able to recover and repair themselves over time.

Radiotherapy can be used for a number of different intended benefits. For example, radiotherapy can be used as a curative form of treatment following surgery, or used as symptom control.  Radiotherapy does not make you radioactive and you are safe to be around all people including children whilst you are on treatment.

The Consultant Clinical Oncologist caring for you will have already discussed the treatment, side effects and gained your consent to proceed with your radiotherapy treatment.  There are several stages prior to you actually commencing your treatment.

Planning your treatment

Your first appointment in the Radiotherapy Department will be a planning appointment. This appointment will be approximately 15-30 minutes in duration. Further information regarding the planning of your treatment is available in the leaflet ‘Introduction to Radiotherapy CT Planning’.

Dependent upon the exact area being treated, you may be asked to have either a full or empty bladder for your scan.  A member of the radiotherapy team will discuss this with you before any procedure is carried out and to obtain your consent for this localisation process.  A specialist X-ray machine called a Computed Tomography (CT) scanner will be used as part of the planning process (Fig 1).  This machine enables us to obtain images of the area of interest whilst you lie on the CT couch; you will move backwards and forwards through the hole of the machine very slowly and you will not feel anything at all.

ctScanner

(Fig 1) CT Scanner

Your course of radiotherapy will be designed on an individual basis and you may be asked to lie on the CT couch face down on your stomach.  You will be required to stay very still in this position for each treatment, so it is important that you are as comfortable as possible.  If you find this position too uncomfortable, let the radiographers know and they can make appropriate adjustments.  They may suggest that you can lie on your back for the treatment if you wish to and this will in no way affect the quality of your treatment.

You will be asked to loosen or remove items of clothing, only in the area being treated, however, you will be provided with a paper sheet to maintain your personal privacy and dignity.  The radiographers may also place a small marker, (approximately the size of a pea,) in between your bottom cheeks; this is not inserted into the back passage and is used only to assist with the planning process.  The staff will then draw some temporary pen marks onto your pelvis area before leaving the room to perform the scan.

Permanent skin marks

During the initial planning appointment, pen marks will be drawn onto your skin to ‘mark on’ the treatment site. As these pen marks will wash off, we prefer to make very small permanent skin marks before you leave the department. These marks are made using a very fine needle and tattooing ink and provide a permanent mark that we can use when delivering your radiotherapy treatment. These permanent marks mean you are able to bathe and shower during treatment as normal.

Radiotherapy Treatment – What happens on the first day?

Each time you attend for your radiotherapy treatment, please book in at the Radiotherapy Reception Desk.  You will be either asked to take a seat in the main reception waiting area or directed to a specific waiting area.

On the first day of treatment, a radiographer will meet with you and have a discussion to explain the possible side effects of treatment, how to minimise them and answer any questions/concerns you may have.

What happens during treatment?

Radiotherapy is delivered using a machine called a Linear Accelerator or Linac for short (Fig 2). Radiotherapy treatment is painless and appointment times are usually 10 -15 minutes.

linearAccelerator

Fig 2: A Linear Accelerator, also known as a ‘Linac’, used to deliver your radiotherapy

Dependent upon the exact area we are treating, you may be asked to have either a full or an empty bladder for your treatment.  The radiographers will instruct you accordingly and you will be required to have the same bladder status, either full or empty, for every daily treatment session.  A member of staff will escort you into the treatment room. A curtained private changing area is available, should items of clothing need to be removed, maintaining your privacy at all times.

The radiographers will then assist you into the correct treatment position on the couch. This will be the same position you were in for your CT planning appointment.  The Linac is then moved into position, ready to commence treatment.  The radiographers are controlling the Linac at all times and the machine may seem close to you but it will not touch you.  Once you are set up in the correct position, the staff will let you know that they are leaving the room for a few minutes to commence treatment.

The machine is being controlled by the staff outside in the control area and it will rotate around you in different directions.  The radiographers are watching you at all times on the TV monitors and should you feel you want to stop the treatment at any time, just wave to attract their attention; the machine will stop and the radiographers will come back into the room.  You will not feel or see anything during your treatment; however, you may hear a buzzing sound when the treatment is being delivered.

Chemotherapy

Depending on the type of cancer you have, you may be required to have chemotherapy at the same time as your radiotherapy.  This will usually be administered in one of two ways:

  • A course of tablets to be taken twice a day throughout your course of radiotherapy.
  • The chemotherapy to be delivered through a drip attached to your arm continuously for five days, once at the beginning of your radiotherapy course and again towards the end of your course. You will be admitted to one of our wards for this treatment to be delivered.

Not everybody requires a course of chemotherapy.  Your Consultant Clinical Oncologist will discuss these options with you.  If you do require chemotherapy, our chemotherapy nurses will discuss the procedure with you and any side effects that may be caused by chemotherapy.

Reviews during treatment

You will have regular weekly reviews with a radiographer as you progress through your treatment to assess how you are coping with any side effects and your general wellbeing.  You may be referred to one of our nursing team if further medical advice or intervention is required.

Please do not feel this is the only time you can voice any concerns regarding your health.  The radiographers will ask how you are feeling every day before treatment.

Side effects of radiotherapy treatment

You may experience some side effects and reactions as you progress through your treatment.  Every individual is different and you may experience some at varying times and levels. This is normal and temporary so please do not worry. You can speak to your radiotherapy team regarding how you can control these and if your symptoms worsen, we can advise and treat you as necessary.

Listed below are some of the most common side effects experienced. These usually begin approximately 2-3 weeks into treatment and may continue for a short while after you have completed your radiotherapy but will then slowly settle down.

Urinary problems

You may experience changes to your urinary symptoms. These include:

  • Burning or stinging sensation when you pass urine, also known as cystitis
  • Passing urine more frequently, especially during the night (nocturia)
  • An increased urgency to pass urine but unable to do so

Following these steps may help with those symptoms

  • Ensure that you are drinking enough fluid and increase the amount if necessary. We recommend that you drink 8 glasses or 2 litres of water a day.
  • Try to limit/avoid smoking, drinking alcohol and caffeinated drinks (e.g. tea, coffee and cola) because they can make urinary problems worse as they can irritate the bladder.
  • Drinking a daily glass of cranberry juice may help prevent urinary infections, though you should NOT drink it if you are taking Warfarin. Please ask your doctor or nurse to check the results of your last blood test before having cranberry juice.

Bowel problems

Changes in your bowel habits/motions may occur as radiotherapy may irritate the bowel. These can include:

  • Loose motions/diarrhoea. You may have to open your bowels more often.  If you have a stoma, you may need to change your stoma bag more frequently.
  • The urge to want to open your bowels more frequently but without passing anything (tenesmus) or only a small stool/mucus, even if you have a stoma.
  • It may also be painful to open your bowels and you may pass some blood. This is quite normal, so please do not worry, but do let your radiographers know that this has happened.

We do not recommend you alter your diet drastically in any way.  However, if you do begin to experience any of the above symptoms, speak to a radiographer or nurse who will be able to advise you.

Skin reactions

Radiotherapy may cause the skin in the treated area to become sore or pink, especially around the groin area and in between the buttocks. Advice will be given on how to care for your skin if this does happen and cream may be supplied. It is also possible you will lose the hair within your pubic region.

Fatigue/tiredness

Some patients may experience feeling more tired than usual during treatment.  This could be due to having to get up several times during the night or travelling a long way for daily treatment.  Be sensible and rest when you feel the need too.  Normal energy levels should return around one month after your treatment has finished.

Late side effects

With the use of modern planning techniques, we aim to reduce the chance of late side effects from happening.  However, late side effects may occur some months or even years after completion of treatment.  Examples of late side effects are:

Bladder

  • Incontinence (unable to hold as much urine as previously).
  • Urinary frequency due to smaller bladder capacity.
  • Thinning of the lining of the bladder.

Bowels

  • Diarrhoea or more frequent bowel movements (this is very common).
  • Narrowing of the bowel.
  • Bleeding from the rectum (if you experience bleeding form the rectum, please contact your clinical oncologist immediately).
  • Inflammation of the lining of the rectum (proctitis), causing bleeding from the back passage (if you experience bleeding from the back passage, please contact your clinical oncologist immediately).

Infertility

  • Radiotherapy to the pelvis is very likely to bring on the menopause in women who are still having regular periods. Your doctor may advise you to start hormone replacement therapy if your symptoms are troublesome.
  • In men, the sperm count may be reduced and some men may notice it is more difficult to achieve an erection following radiotherapy. If this is a problem for you, your doctor will be able to give you advice.

What happens when I finish treatment?

Once you have completed your course of radiotherapy treatment, you will receive a follow-up appointment with your consultant oncologist or a member of their team. This appointment will be sent out in the post for you to return to see the consultant oncologist at the hospital where you were first seen.   This is usually around 4-6 weeks after treatment has finished allowing any side effects you may have experienced to settle down. Your consultant will then decide if any further test/appointments are necessary.

Radiotherapy may cause scarring and narrowing of the vagina therefore pelvic care is recommended after treatment which aims to reduce these problems.  Women who have received radiotherapy to the anal canal are advised to use their vaginal dilators approximately 6 weeks after finishing their radiotherapy. Please refer to your ‘Vaginal Dilator’ information leaflet and if you require further guidance, contact your clinical nurse specialist or brachytherapy radiographer.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Radiotherapy Information and Support Team on telephone number:(01482) 461206

 e-mail: Radiotherapy.Info@hey.nhs.uk

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

Radiographers

These highly trained specialists help in several aspects of your treatment from CT, simulator and treatment.  You will see where possible the same team of radiographers each day you attend for your treatment.  They are there to help you if you have any problems or worries, please speak to them for any help and advice.  You may also be referred to another member of the oncology team as necessary.

Radiotherapy Nursing Team

The team consists of Registered Nurses and Clinical Support Workers (CSW), who are based within the Radiotherapy Department where they actively support and advise patients receiving radiotherapy treatment.  They are able to make appropriate referrals and offer advice to patients and their families/carers.

Health Centre

The primary aim of our Health Centre is to help patients and their families to have the best possible health and quality of life during and after treatment.  The Health Centre is open to all oncology patients and their families in offering an informal atmosphere to those who wish to “drop in” to the centre.  Within the Health Centre, there are specially trained staff who are able to advise you on different aspects of coping with cancer.

The centre is located in the Main Reception of the Queen’s Centre for Oncology and Haematology at Castle Hill Hospital.

The opening times are Monday – Friday 9:00am to 5:00pm

Useful Numbers

Listed below are the contact details of useful organisations that provide information about cancer including radiotherapy treatments:

Macmillan Cancer Support

Provide information from specialist nurses on all aspects of cancer and its treatment as well as the practical and emotional aspects of living with cancer.

You can drop into the Macmillan Cancer Information Centre within the Queen’s Centre or call on: (01482) 461154 (Monday – Friday 9:00am to 5:00pm)

Alternatively free phone the national help line: 0808 808 0000 (Monday – Friday 9:00an to 8:00pm) Online: http://www.macmillan.org.uk

Write to: Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ

 PALS (Patient Advice and Liaison Service)

Provide confidential advice and support, helping you to sort any concerns you may have about the care we provide, guiding you through the different services available from the NHS. Telephone: (01482) 623065 (Monday – Friday 9:00am to 4:00 pm) Email: pals@hey.nhs.uk

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.