The Christie Charity
This information is about radiotherapy to the skin. The Christie is a specialised radiotherapy centre – patients come for treatments that are not available in general hospitals.
How does radiotherapy work?
Our bodies are made up of cells and all cells have the capacity to divide. If radiation hits a cell that is dividing, the cell will be damaged. Cancer cells are much less able than normal cells to repair the damage, so more of the cancer cells will be destroyed.
There are different types of radiotherapy used in the treatment of skin cancer: superficial, electron and brachytherapy. Photon radiotherapy may also be used in some cases, for example to treat lymph nodes.
- Superficial radiotherapy uses X-rays that do not travel far into the skin before they are absorbed.
- Electron radiotherapy uses electron beams that can travel deeper into the skin and underlying tissues.
- During brachytherapy, the radioactive source is placed directly over the skin cancer in a specially designed plastic treatment mould.
Your doctor will advise you about the type of treatment that is appropriate for you and how long the treatment lasts. All superficial and brachytherapy treatments are given at The Christie in Withington. Electron treatment is also given at Withington, and it may be possible to have this treatment at The Christie at Oldham or Salford.
Agreeing to treatment
Consent to treatment
The doctors, nurses and radiographers will give you some written information to support what they have said about your treatment. At the time your treatment is being planned, you will have a further opportunity to discuss anything that you do not understand or any anxieties you may have.
We will ask you to sign a consent form agreeing to the treatment that you are being offered. The basis of the agreement is that you have had The Christie’s written description of the proposed treatment, and that you have been given an opportunity to discuss any concerns.
You are entitled to request a second opinion from another doctor who specialises in treating this cancer. You can ask your own consultant or your GP to refer you.
Your consent may be withdrawn at any time before or during this treatment. Should you decide to withdraw your consent then a member of your treating team will discuss the possible consequences with you.
Radiation can be harmful to the unborn child. It is important to let the radiographers know if you have missed a period or suspect that you might be pregnant before you are exposed to any radiation.
What are the benefits of this treatment?
Radiotherapy works by damaging cancer cells while causing as little damage as possible to normal cells. The benefits of treatment vary from one person to another depending on your disease. The aims of treatment may include an attempt to:
- cure the cancer, or
- reduce the chances of the cancer coming back, such as after surgery, or
- shrink the tumour which may slow down its progress and give relief from troublesome symptoms
Are there any alternatives to this treatment?
The doctor at your local hospital may have advised you about any other possible treatments before referring you to The Christie. Your Christie consultant will be happy to discuss any questions or concerns you may still have.
What will happen if I do not have this treatment?
There is a risk that your cancer may continue to grow, and your symptoms may get worse. You can discuss what to do next with your doctor.
Preparation for treatment
A team of doctors including consultants and registrars as well as radiographers will care for you. This team will not necessarily include the doctor who saw you first, but one consultant will be responsible for your treatment.
Your doctor will advise you which radiotherapy treatment (superficial, electron or brachytherapy) is appropriate for you. This depends on the size, site and depth of skin that needs treatment, and we will explain this to you before treatment begins. In addition, your doctor will mark out the area on your skin that needs treatment.
Superficial treatment
You will need to wait for half an hour to an hour for the treatment to be calculated. You will usually be treated on the same day as planning.
Superficial treatment may be done in one visit or sometimes multiple visits are necessary.
If your treatment is near the eye, you may need to wear a protective contact lens. This will be inserted after using local anaesthetic eye drops. The eye will need to be covered for at least 4 hours afterwards. In these circumstances, it is best not to drive yourself to the hospital.
Electron treatment
The treatment is given over the course of a few days, and you may not start your treatment on the same day as planning.
Brachytherapy treatment
The treatment is given over the course of a few days (sometimes more than once per day) and will start usually within 2 weeks of planning. Planning will involve a CT scan.
Mould room preparation
Some patients may need to have an individual shield made for them. This may apply to patients having electron or superficial treatment. This will involve an outpatient visit to the mould room at The Christie in Withington 1 week before starting radiotherapy.
Patients having brachytherapy will have an individual mould made of the treatment area. Another appointment will be made following this to attend for a CT scan, which is to plan the brachytherapy treatment. Treatment will usually start about one week after this scan.
What happens when you have superficial, electron or brachytherapy treatment?
On the day of treatment, you will come to the radiotherapy department. Radiographers operate the radiotherapy machines to give you the precise treatment prescribed by the doctor. They will explain to you what is going to happen and take you into the treatment room.
The radiographers will ask you to remove any clothing that covers the area being treated. The radiographer will adjust both the bed and the machine to the exact positions that are needed. The machine will rest gently on your skin. You will be asked to keep as still as possible.
The treatment is painless. It is just like having an X-ray taken, but it takes slightly longer. When all the adjustments have been made, the radiographers will leave the room and will switch on the machine from outside.
The treatment itself normally lasts less than 5 minutes. However, the treatment session may take about 15 minutes, allowing time for discussion and the machine to be set up.
During your treatment you will be alone in the room, but the radiographers will be watching you carefully on a closed-circuit television (CCTV) system. If for any reason you need them, just raise your hand and they will interrupt the treatment and come in immediately. Afterwards, the treatment will continue as planned.
Treatment schedule
The prescribed radiation dose and the number of days over which it is given varies between patients. Some people may only need one treatment but if your doctor prescribes more than one treatment, we will give you an appointment to attend the following day.
There is usually no radiotherapy treatment on Saturdays and Sundays, and this is considered when your treatment is planned. Sometimes treatment is given on bank holidays. You will usually be treated on the same machine throughout your course of radiotherapy. Do not worry if you are asked to move to another machine as your treatment will remain the same.
If you have any questions about what will happen during your treatment, please call the radiotherapy department on 0161 446 3485.
It is very important that you do not miss treatment days as it may make your treatment less effective. If you feel you are unable to attend for any reason, please call and discuss the problem with a radiographer.