Radiotherapy for Lymphoma

Radiotherapy for Lymphoma

Side effects of radiotherapy

Effects on the Skin

• Radiotherapy may cause a skin reaction in the treatment area similar to exposure to the sun.
• Towards the end of treatment, the skin may become red and/or dry and itchy and the reaction may continue to develop after the treatment has finished. You can help yourself by:
• Washing daily with tepid water and using a mild, non-perfumed soap will help. If you are going to shave in the treatment area, please use an electric razor as this will lessen the possibility of skin irritation. 
• Do not use sunbeds on the treated area and avoid any extremes of temperature, e.g. saunas, hot water bottles.
• Try to wear loose clothes in the treatment area as this can reduce any irritation and friction
• You may find it helpful to use a moisturising cream in the treatment area. There are no specific recommendations for one product over another due to lack of evidence, so it is fine to use a cream you are familiar with. 
• Apply the cream thinly and often but not right before radiotherapy treatment.
• Stop using creams if skin becomes irritated, peels or blisters and talk to you radiographers for further advice.
• You may temporarily lose any body hair in the treatment area.  This normally grows back but may be thinner or of a different texture.

Effects on your mouth and throat

If your mouth is included in the treatment area you may experience some of these side effects-:

• The saliva in your mouth may become thicker and the mouth may feel dry.
• Food may become tasteless.
• The inside of your mouth may become painful and sore and there is a small possibility that you may develop some ulcers in your mouth. These effects may develop after treatment has finished as the effects of radiotherapy continue to work. 
• If your throat is in the treatment area there is a small possibility that swallowing may feel difficult or uncomfortable.
• You may experience an irritating cough, especially when you lie down. It may be helped by frequent sips of fluid (carry a bottle of water around with you). 
• Avoid drinks that may further dry your mouth such as alcohol. 
• Pain relief medication can be prescribed by your consultant or member of the team if needed.

Effects on other parts of your body

If your stomach is included in the treatment area you may experience-

• Feelings of nausea and vomiting
• Loss of appetite

Anti-sickness medication will be available if you require it. 

If your pelvis is included in the treatment area you may experience-

    Urinary changes including frequency and urgency

• Slower flow
• Stinging or discomfort when passing urine
• Bowel changes including increased frequency of motion
• Looser stools
• You may experience some temporary hair loss in the treatment area.

If your face or eyes are included in the treatment area you may experience –

• A sore mouth and/or some swallowing difficulties,
• Irritation of the eye, difficulty tolerating light and sticky eyes.

Swelling

Lymphoedema is a condition that can occur as a side effect of radiotherapy.  This can occur if the treatment area is near the lymph nodes in the arm or leg.  This results in swelling which may be noticeable in the affected limb.  You may also experience a feeling of heaviness, tightness or discomfort in the affected limb.  This can continue in the years after treatment.

Gentle exercise can help to promote fluid drainage and maintain mobility.  Your Doctor and the Review Radiographers will be able to give you more information on managing lymphoedema.

Tiredness 

Most patients having radiotherapy feel more tired, particularly towards the end of treatment. If you feel tired, you may need extra rest. However, evidence suggests that gentle exercise such as a short walk can also help. 

If you regularly exercise, it is acceptable to continue with your normal exercise routine unless the treatment team advise against this.

If you have any of the above side effects, then please let your treatment radiographers know as there is support and advice available to help you manage them.

Late or long-term effects after treatment

The side effects from the treatment will continue for several weeks to months after the treatment course has been completed. 

Skin changes

Redness, soreness and itchiness will recede after the treatment.  Occasionally, the skin in the treatment area may remain a slightly different colour and tiny “spider” veins may develop around the treatment area.

Dry mouth

This can occur if the salivary glands in your mouth were in the radiotherapy treatment area and may be permanent.  Your doctor and/or nurse specialist will be able to advise of products you can use to help with this,

The treatment can also cause an increase in dental problems.  Please advise your Dentist if you have had radiotherapy to your mouth, face or neck.

Cataracts

This will only occur if your eye is in or near the treatment area.  You may find that you suffer from dry, itchy eyes and may require eye drops.

Underactive thyroid gland (hypothyroidism)

If your thyroid gland in your neck is close to or in the treatment area, there is a small risk of developing an underactive thyroid gland years later.

Symptoms of hypothyroidism include tiredness and weight gain.  Your GP will be able to arrange blood tests if needed.

Chest

If your heart is near or in the treatment area there is a risk of developing heart problems years later.  This could include angina or heart attacks.  Try to maintain a healthy lifestyle.

Treatment to the lungs can cause inflammation or scarring to lung tissue.  You could develop a cough or shortness of breath.

Abdomen and Pelvis

Radiotherapy to the abdomen can cause impairment of various organs

If one or both kidneys are partially or completely included in the treatment area there maybe a worsening of kidney function. 

If your spleen is in or around the treatment area you may be at increased risk of infections. 

If your pancreas is in the treatment area there may be an increased risk of diabetes

Infertility

If the testes or ovaries are near the treatment area the radiotherapy treatment can impact on fertility.  The treatment can cause temporary or permanent infertility, depending on the dose, location and individual factors.

Radiotherapy to the abdomen or pelvis can affect ovarian function, potentially leading to a reduction in fertility or early menopause.

If the testes are near the treatment field the radiotherapy can cause damage to sperm leading to temporary or permanent infertility.  Treatment can also cause low testosterone levels.  You may wish to discuss sperm banking with your doctor before treatment starts.

Even though the radiotherapy may affect fertility, it does not guarantee that infertility will occur.  Contraception should still be used during and after radiotherapy as pregnancy may still be possible.

Secondary Cancers

After radiotherapy treatment, there is a small risk that another cancer may develop years later.  Please discuss with your doctor, GP and nurse specialists if you need further help and advice on maintaining a healthy lifestyle.

If you develop new symptoms after your treatment is over, or you are concerned that the immediate side effects are not clearing up, you can contact the Macmillan Radiotherapy Specialist Radiographer on 01905 761420 or The Acute Oncology service on 01905 760158. 

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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