Having external radiotherapy for mouth and oropharyngeal cancer

You usually have external radiotherapy for mouth and oropharyngeal cancer. External radiotherapy uses a machine outside the body to direct radiation beams at the cancer. It uses high energy x-rays to kill cancer cells.

You usually have a type called intensity modulated radiotherapy (IMRT). Intensity modulated radiotherapy (IMRT) is a type of conformal radiotherapy. This means shaping the radiation beams to closely fit the area of cancer and sparing other areas. This way, it prevents severe side effects

When you might have external radiotherapy

Radiotherapy as your main (primary) treatment

You might have radiotherapy as your main treatment for oropharyngeal cancer. This is usually if you have a small, early stage cancer. You may have it with or without chemotherapy.

Radiotherapy is not usually a main treatment for mouth cancer, but you may have it if you:

are not fit enough for surgery
don’t want surgery
have early stage lip cancer

You usually have 30 treatments over 6 weeks. You have the treatment in short sessions (called fractions). You have it daily from Monday to Friday. You don’t have treatment at weekends.

Radiotherapy is also a main treatment for early stage lip cancer. You might have 15 treatments over 3 weeks.

Radiotherapy after surgery

This is called adjuvant therapy. It aims to kill any remaining cancer cells after surgery and It helps to stop your cancer from coming back.

You may have it because:

your tumour was difficult to remove
your surgeon thinks there may be cancer cells left behind
the tumour had spread locally into nearby structures
your doctor found cancer cells in your lymph nodes

You have adjuvant radiotherapy on its own or together with chemotherapy.

You usually have around 30 treatments over 6 weeks.

Radiotherapy with chemotherapy

You might have chemotherapy together with radiotherapy. This is called chemoradiotherapy.

You might have chemoradiotherapy:

as your main treatment for oropharyngeal cancer if surgery is not a suitable option
after surgery for mouth cancer that has spread into surrounding tissues or into nearby lymph nodes
after surgery for oropharyngeal cancer that has spread into surrounding tissues or outside lymph nodes
for advanced oropharyngeal cancer

Radiotherapy with a targeted drug

You might have radiotherapy with the targeted drug Open a glossary item cetuximab if you can't have chemotherapy. This is for locally advanced squamous cell cancer.

Radiotherapy if your cancer comes back

You might have radiotherapy if your cancer comes back. This will depend on whether you had radiotherapy or surgery before.

Radiotherapy to control symptoms of advanced cancer

Radiotherapy can help relieve symptoms of advanced cancer. You may hear this called palliative radiotherapy. The treatment can relieve symptoms, such as pain, caused by cancer spreading.

There are several different treatment schedules. You may have one treatment, 10 treatments or more. Your doctor will discuss this with you and explain the length of treatment that is suitable for you.

Types of radiotherapy

You usually have intensity modulated radiotherapy (IMRT) for mouth and oropharyngeal cancer. IMRT is a type of external radiotherapy.

You might also have internal radiotherapy for mouth cancer. Internal radiotherapy gives radiotherapy to the cancer from inside the body. This is also called brachytherapy. It is only available in a few specialist centres. Your doctor will tell you more about this treatment if it is suitable for you.

The radiotherapy room

Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine might be fixed in one position. Or it might rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.

Before your first treatment, your radiographers Open a glossary item will explain what you will see and hear. In some departments, the treatment rooms have docks for you to plug in music players. So you can listen to your own music while you have treatment.

Before each treatment session

The radiographers help you to get onto the treatment couch. They fit your radiotherapy shell (mask). You keep it on during your treatment session. It will help you to keep very still when you have radiotherapy.

The radiographers line up the radiotherapy machine using the marks on the mask. Once you are in the right position, they leave the room.

During treatment

You need to lie very still. Your radiographers might take images (x-rays or scans) before your treatment to make sure that you're in the right position. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.

Your radiographers can see and hear you on a CCTV screen in the next room. They can talk to you over an intercom and might ask you to hold your breath or take shallow breaths at times. You can also talk to them through the intercom or raise your hand if you need to stop or if you're uncomfortable.

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Transcript

Daniel (radiographer): Before your treatment starts your doctor will need to work out exactly where the treatment needs to go and also which parts need to be avoided by the treatment.

To have radiotherapy you lie in the same position as you did for your planning scans.

To stop you moving and to make sure your treatment is directed at the cancer you wear a custom mask over your face which is attached to the couch.

We line up the machine using marks on your mask and then leave the room. We control the machine from a separate room this is so we aren’t exposed to radiation.

Treatment takes a few minutes and you’ll be able to talk to us using an intercom. We can see you and hear you while you’re having treatment and we will check that you’re OK.

When your treatment starts you won’t feel anything. You may hear the machine as it moves around you giving the treatment from different angles.

Because we’re aiming to give the same treatment to the same part of the body every day the treatment process is exactly the same every day so you shouldn’t really notice any difference.

You’ll see someone from the team caring for you once a week while you’re having treatment. They’ll ask how you are and ask about any side effects.

You won't be radioactive

This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.

Travelling to radiotherapy appointments

You might have to travel a long way each day for your radiotherapy. This depends on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.

You can ask your radiographers for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7 am till 9 pm.

Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or discounted parking. They may be able to give you tips on free places to park nearby.

Hospital transport may be available if you have no other way to get to the hospital. But it might not always be at convenient times. It is usually for people who struggle to use public transport or have any other illnesses or disabilities. You might need to arrange hospital transport yourself.

Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this and hospital transport.

Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.

Side effects of treatment

Radiotherapy for mouth or oropharyngeal cancer can give you:

red or sore skin around the area
dry and sore mouth
taste and smell changes
voice changes
nausea (feeling sick)
eating and drinking problems
reduced or sticky saliva