This is a treatment where high energy X-rays are directed at a cancer to cure or shrink the cancer. In Lymphoma the X-rays are delivered through a machine such as a linear accelerator or cobalt machine. This is known as external radiotherapy.

Radiotherapy is a local form of treatment. It only affects disease in the area being treated. It may be used on its own when the lymphoma is confined to one or two groups of lymph nodes in the same part of the body. It can also be used before, during and after a course of chemotherapy for more widespread disease. Radiotherapy can be used if the lymphoma has spread to the fluid around the brain or if there is a high risk that it may develop there.

Radiotherapy can also be used if you have lymph nodes that are very swollen and causing you discomfort or pain.

In most cases radiotherapy is not only given to the affected lymph nodes but to lymph nodes close by as well.

Planning your treatment

Before radiotherapy your doctor and other specialists, plan how best to deliver your treatment to you. They work out how to give you the right amount of treatment for the cancer with the least damage to normal cells.

You may have to have radiotherapy to your head or neck. The head is one of the most difficult parts of the body to keep steady during treatment. Therefore, a mould of your head is made for you to wear during each visit for treatment. The mould is attached to the couch you are lying on during treatment. This will ensure that the radiotherapy is delivered to the same area each day. The areas for treatment will be marked on the mould by ink.

On your first visit to the radiotherapy department you will be asked to lie on a couch. A quick setting cream will be applied to your face or neck, depending on which area is to be treated. Holes are left around your eyes, mouth and nostrils so that you can breath. The cream will be lifted off as soon as it has set and a mould will be made of the impression. When the mould is ready the next part of treatment planning will take place. You will be asked to lie under a simulator that takes X-rays of the area to be treated.

If you need radiotherapy to another part of the body such as the chest, you will be marked on the skin where the treatment is to be delivered. This may be with ink or a permanent tattoo. By doing this, the rays can be directed at the same area each day. Before treatment can go ahead you will be asked to lie under a simulator that takes X-rays of the area to be treated. The ink marks are temporary and should not be washed off until treatment is over.

Treatment planning is a very important part of radiotherapy and it may take a few visits before your treatment can go ahead. Before starting radiotherapy you will be told how to look after your skin during and after treatment.

Getting your radiotherapy

Treatment with radiotherapy is quite straightforward. You will be asked to come for treatment every day during the week with a rest at weekends. Your treatment programme can go on for 4-6 weeks. Each treatment session only takes a few minutes. You will not feel any pain but you will have to lie still during treatment. How much radiotherapy you need will depend on the size and number of lymph nodes involved. Your doctor will discuss this with you.

Each time you go for treatment you will go into a radiotherapy room. The therapy radiographer (the person who works the X-ray machine) will ask you to lie or sit in a certain way under the radiotherapy machine. When you are ready he or she will leave the room. The machine will then be turned on and your treatment given. Even though you are on your own in the room the radiographer will be able to see you all the time through a closed circuit camera. You can talk through an intercom to the radiotherapy staff if you need to.

External radiotherapy does not make you radioactive. It is perfectly safe for you to mix freely with family and friends.

Will you have any side effects?

Radiotherapy is given directly to the site of the lymphoma and nearby lymph nodes. Therefore, the side effects that occur are related to the part of the body being treated.

Some people have only mild symptoms while for others the side effects can be more severe. It depends on how much treatment you require and what part of the body is being treated.

The most common side effects that may occur are:

Difficulty swallowing or sore throat

If you have radiotherapy to the neck or chest you may notice after

a week or two of treatment that your chest feels tight and you have difficulty swallowing. It may feel like you have a lump in your throat all the time. Your throat may also feel dry and sore. This is a common reaction to treatment. You may find it helpful to eat soft foods. If you find it difficult to eat your normal foods high-calorie liquid supplements may help. Your doctor may give you medicine to take before meals to make swallowing easier.

The discomfort will usually get better on its own in about five to eight weeks.

Sore mouth

Radiotherapy to the glands in the neck may cause a sore mouth. Little ulcers may appear on the tongue, gums and inside the cheeks of your mouth. Try to keep your teeth, gums and mouth very clean, as this will reduce the risk of getting a mouth infection. Clean your teeth after each meal. Use a very soft toothbrush. If you have dentures remove them if your gums are sore. There are special mouthwashes that you can use. Your nurse will show you how to use them properly.

You may also notice that your mouth feels dry and you have a loss of taste or a metallic taste in your mouth. This is because your salivary glands may produce less saliva than usual during treatment.

Radiation may increase the chances of you getting cavities in your teeth. Go to your dentist for regular check-ups. This will help reduce the risk of tooth decay.

Feeling sick or getting sick

Your nurse can give you tablets to help prevent this.

Take them one hour before treatment. Eat small amounts often.

Weight loss

If you have problems with eating or sickness you may begin to lose weight. It is best to try to eat as well as you can while on treatment. Ask to see a dietician if you are losing weight. He or she will give you advice on the best foods to eat.

Skin changes

During radiotherapy the skin in and around the treated area may become red and sore. It may look like sunburn. A special cream can be used for this problem. Only use creams recommended to you by the nurses or by the therapy radiographers. If you need to wash the area use warm water and pat it dry with a soft towel. Do not rub the skin while washing and drying. If you shave use an electric razor. Avoid perfumed creams or powders.

Check with your radiographer or nurse before applying anything to your skin.

Tiredness

This can build up over the course of your treatment. It may be due to the treatment itself or maybe you have to travel long distances to come for treatment.

Rest as much as you can. Cut down on the things you normally do while you are on treatment.

Shortness of breath

After radiotherapy to the chest you may develop a dry cough and shortness of breath. Radiotherapy can interfere with the ability of the lungs to supply the body with oxygen. This condition is known as radiation pneumonitis. It can occur several months after treatment has ended.

Do tell your doctor as soon as possible if you develop these symptoms. He or she may want to treat you with medication.

Hair loss (alopecia)

Hair loss will occur if you have radiotherapy to any part of the body where there is hair. Before treatment starts ask your doctor if you are likely to lose your hair. You will only lose hair within the treatment area. The hair loss may be patchy. If you are having radiotherapy to the head you may have hair loss from the scalp. If this happens it will fall out quickly but try not to worry, as your hair will start to grow again when treatment ends.

You may feel upset at the thought of losing your hair. Talk to your nurse or social worker about your feelings. He or she will help you find ways to cope with hair loss. You can get a wig if this happens or you may prefer to wear a scarf or hat.

If you would prefer a wig it is better to organise one before treatment starts. By doing this you will get a better match to the colour of your hair. Your social worker or nurse may be able to arrange a wig for you. If your hospital does not have a social worker ask if they have the name of a wig fitter you could go to see. Your local hairdresser may be able to help. In some cases it is possible to get financial assistance towards the cost of a wig. Ask your social worker or nurse. For some patients the amount of hair loss is small. A wig may not be needed.

Diarrhoea

Passing watery bowel motions more than twice a day is known as diarrhoea. You may also have cramping and/or abdominal pain. Drink plenty of clear fluids. This will help to replace the fluid you are losing. Let your doctor know if the diarrhoea persists for 24 hours. There are tablets that can stop this side effect of treatment.

These or any other effects you develop will be monitored very carefully during the radiation treatments. Your doctor or nurse will give you information on how to prevent or reduce side effects and medication will be prescribed if needed.

Most of these side effects should go away when treatment is over, but do let your doctor know about them if they continue

Radiotherapy is where high energy X-rays are directed at the cancer to cure or shrink the cancer.

You will not feel any pain while you are getting treatment. Each session only takes a few minutes.

Treatment may continue for 4-6 weeks depending on the cancer