Radiotherapy for secondary cancers

What is radiotherapy?

Radiotherapy uses precise, carefully measured doses of high energy x-rays to treat cancer. Cancer cells are more sensitive to radiation than normal cells, so the aim of treatment is for the x-rays to either destroy the cancer cells or stop them from growing, whilst avoiding and protecting the normal cells as much as possible.

Radiation also affects normal cells in or around the area being treated which causes side effects, but these will usually recover and heal after treatment.

What is secondary cancer?

Secondary cancer develops when cancer cells, which have arisen from another part of the body (known as the primary cancer), develop and grow in another area of the body.  This causes changes which can result in pain and/or swelling, bleeding or other symptoms. There may be a risk of the bone breaking (fracture) if it has spread to a bone.

Occasionally, the diagnosis of cancer is made unexpectedly following the investigation of persistent bone pain or fracture. Secondary cancer may also be referred to as “metastases” or “metastatic cancer”.

Why use external beam radiotherapy to treat secondary cancers?

The aim of your treatment is to relieve your symptoms, such as relieve pain and slow down the activity of the cancer in the treated area. The disease can weaken the bone, so radiotherapy is also given to try to prevent fractures.  When the risk of fracture is high, you may be considered for surgery, which can involve the placement of metal pins or plates into the bone to strengthen it. Radiotherapy may be given between a few weeks and a few months after surgery depending on the individual case.

The number of treatments you need depends upon several factors, such as which part of the body needs treatment and the size of the area. It is common to treat secondary cancer with one treatment, known as a single session. Sometimes, five or more treatment sessions, known as a course, or fractionated radiotherapy, are used. Your doctor or radiographer will explain how many treatments you will need and what side effects to expect.

You will need to attend the radiotherapy department as an outpatient for your treatment (Monday to Friday).

Your radiotherapy planning appointment

Prior to your radiotherapy treatment starting, you will need to attend the radiotherapy department for a CT planning scan. The position you are in for this scan will be the exact same as the position you will be in for your treatment. It is important that you tell us if you find this position uncomfortable before we carry out the scan. There are often adjustments we can make to help make you as comfortable as possible.

Unless you have been told otherwise by your doctor, please continue taking your medications as normal before your appointment. If you take any medications to help manage your pain it is advisable to take these to make lying on the couch as manageable as possible for you.

Your radiotherapy treatment appointments

The actual radiotherapy treatment is like having an x-ray/scan. Each session takes approximately fifteen minutes in total, most of which is spent ensuring you are in the correct position. The actual delivery of the radiation lasts only a few minutes. You will not be radioactive after treatment.

We will regularly take x-ray images before delivering your radiotherapy treatment to confirm that the area we intend to treat is in the correct position.

If you took pain relief for your planning appointment or if you found the position you were in uncomfortable, we recommend you use your standard pain relief for this appointment. If you feel you need additional pain relief, please discuss this with the radiographers who will be able to advise you or discuss with a doctor as needed.

Side effects of radiotherapy treatment

Short term

Some side effects are short term, or “acute”. Short term side effects typically reach their peak about two to three weeks after you finish your treatment and take a further two to three weeks to reduce, however this will not be the case for all patients. Examples of possible short term side effects from radiotherapy for secondary cancers are listed below. 

• Within the first few days, you may notice a temporary increase in pain in the treated area, particularly if you have a single treatment. During this time, if any pain is not under control with your usual medicines, you should contact your GP, district, or Macmillan nurse.
• Depending on the area being treated you may also feel nauseous following radiotherapy. Your treating team will discuss this potential side effect with you and provide you with medication to support where necessary.
• When treating the abdomen or pelvic areas, you may notice that your poo becomes more frequent and looser for a short time (diarrhoea). This occurs because we cannot avoid bowel which lies in front of/close to the area(s) receiving treatment.

Radiotherapy to the pelvis can sometimes include treating some of the bladder, which may cause temporary symptoms, eg the need to wee more frequently and discomfort. It is a good idea to drink more fluid until the symptoms settle.

When the back bones (spine) of your chest or neck area are treated, it is possible that your throat could become a little sore for a short time as these areas lie in front of the spine and may receive some radiation dose. If this soreness is troublesome, painkillers may be helpful as well as eating softer foods and avoiding very hot or very cold food and drink until it settles.

When treating the chest, we may cause some irritation to the lungs leading to a mild cough or some shortness of breath.  This will settle a few days after treatment has completed.  Your treating team will discuss this side effect with you.

You may lose some hair in the area you have treatment. This often grows back but may be thinner and/or a different texture than before.

Your skin may become discoloured in the treated area. We advise you not to soak in hot baths, to use a mild, non-perfumed soap and to pat the area dry rather than rubbing. Please do not use talcum powder or any lotions and creams other than those advised by us. Please ask one of your radiographers for information on this.

You may become tired. Gentle exercise may help but save your energy for activities you enjoy doing.

You may experience some or all these side effects. Please always let the radiotherapy team know of anything worrying you, as we want to help you recover as soon as possible.

Long term

Some side effects are long term. These usually occur more than three months, but sometimes much longer, after finishing your course of treatment.

It is unusual to have long term side effects following a course of radiotherapy for secondary cancers, however please let your doctor know if this does happen – you may require additional tests and there may be treatments that can be offered to help.

After your treatment

Follow up from radiotherapy can vary depending on the treatment you have received. Sometimes you may be referred back to the team overseeing your care as a whole for follow up and sometimes you will be followed up by your radiotherapy doctor.

Usually, you should expect an outpatient appointment to be arranged for between 4 weeks and three months from completing your treatment. This may sometimes be a telephone appointment.

If you have any concerns about your follow up, please speak to the radiographer team, or contact your clinical nurse specialist or your oncology team’s secretary.

Support available

We have several support services are available, for you to access. If you would like to know more about these, please read our leaflet titled “a patient’s guide to radiotherapy” or ask a member of the radiotherapy team.