Radiotherapy for skin cancer

Radiotherapy uses high energy x-rays to kill cancer cells. There are 2 main types of radiotherapy, external and internal radiotherapy (brachytherapy).

External beam radiotherapy directs radiotherapy beams at the cancer from a machine. This is different to internal radiotherapy. Internal radiotherapy means giving radiotherapy to the cancer from inside the body.

You usually have external radiotherapy for non melanoma skin cancer. But in some cases, your doctor might use brachytherapy instead. But this is less common.

Superficial radiotherapy is another type of external radiotherapy. It treats cancer on or close to the skin surface. Superficial radiotherapy means that the radiation doesn't travel far into your skin.

When do you have radiotherapy?

Radiotherapy is a treatment for non melanoma skin cancers such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). It's a treatment for skin cancers:

that cover a large area
in areas of the body that are difficult to operate on
where the appearance after surgery may be poor
in people who don't want surgery
in people who aren't fit enough for a general anaesthetic

You might have radiotherapy after surgery to try to lower the risk of the cancer coming back (adjuvant treatment).

Or you might have radiotherapy if your cancer has spread to your lymph nodes or another part of your body, such as the lungs.

Before you have it

Before you have radiotherapy treatment it needs planning. This is to work out the amount (dose) of radiotherapy you need and exactly where you need it.

How you have it

You have radiotherapy treatment in the hospital radiotherapy department. The number of treatments you have depends on the type of skin cancer you have, where it is and how big it is.

You usually have radiotherapy once a day, from Monday to Friday. You have a rest at the weekend. The length of treatment varies from one to about 6 weeks.

Older and frail people may have their radiotherapy treatment less often. So they don't need to attend the radiotherapy department daily. Some treatment plans might be once a week or 2 to 3 times a week.

Some people might have a single treatment of radiotherapy.

Your doctor will tell you what treatment plan is best for you.

The radiotherapy room

Before you start your course of treatment your radiographers explain what you will see and hear. In some departments the treatment rooms have docks for you to plug in your music player. So you can listen to your own music.

During the treatment

You can't feel radiotherapy when you actually have the treatment. But the machine makes whirring and beeping sounds. It will also be gently touching your skin so you might feel a light pressure, but it won’t hurt.

Because your position is so important, the radiographers may take a little while to get you ready. They have to place shields or moulds in the correct position. They might also take images (x-rays or scans). You can help by trying to relax as much as possible during this time.

Once you are in the right position your radiographers leave you alone in the room. This is so they are not exposed to the radiation. You will be alone for anything from a few minutes up to 15 minutes.

Your radiographers can see and hear you on the close circuit television (CCTV) screen in the next room at all times. 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

Dan (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. We then line up the machine based on your tattoo marks. It is really important that you stay very, very still when you are having treatment it is also important to let the radiographers know right at the beginning if you are not comfortable so they can adjust your position

Radiographer: Ok all done, we’ll be back in a couple of minutes

Dan (radiographer): We leave the room and control the room from a separate room This is so we aren’t exposed to radiation. Treatment takes a few minutes and you will be able to talk to us using an intercom. We can see and hear you while you are having your treatment and will check that you are 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 are aiming to give the same treatment to the same part of the body everyday then the treatment process is exactly the same everyday so you shouldn’t notice any difference. You’ll see someone from the team caring for you once a week while you are having treatment they’ll ask how you are and about any side effects.

Patient: They get you from one sitting area to another and then take you into the room where you undress to the waist and then lie down and line you up by either moving you or asking you to shuffle a little and they check the dimensions and they talk to one another and they say I am fine this side how are you ...yes fine...ok, stay where you are Jeff and that was it. There were a few little clicks and lights go on and off and you can see a green laser beam which line sup with certain things on your body uh so no, no real noise and no discomfort.

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.

Side effects of radiotherapy treatment

All treatments have side effects and these vary from person to person. You may have one or a combination of several. This is a list of some of the side effects you might get from radiotherapy treatment for skin cancers:

Sore, dry or itchy skin

Radiotherapy to the skin can cause the skin at the site to become red and sore during treatment. This will begin to disappear once the treatment has finished. Or if you have treatment over a short amount of time it may happen after you finish.

It can also cause your skin to feel dry and itchy. Try not to scratch the skin. Ask if there is anything you can use to ease the itching and dryness.

Your skin might become crusty and scab over

The skin may become crusty and scab over. When the scab falls off, there'll be new skin underneath. This area will be more sensitive to the sun in the future. This may happen more than once until your skin starts to heal.

Hair loss

You might have some hair loss if you’re having radiotherapy to a part of the body that has hair. Your hair usually grows back some time after treatment. But hair loss can be permanent. It can take a while for your hair to grow back as it depends on the amount of treatment you’ve had to that area.

Bleeding

You might have some bleeding at the radiotherapy site. Apply some pressure with a clean dry dressing until the bleeding stops. Follow the advice given to you by your team.

Infection

Keep a close eye on the area of skin that is having radiotherapy treatment. If you notice signs of infection such as ooze that is green or yellow in colour or doesn’t look quite right, contact your advice line. You might need to see your GP or dermatologist for antibiotics.

Looking after your skin during radiotherapy treatment

Your radiotherapy team will tell you how to care for your skin during and after treatment.

Tips for looking after your skin:

Gently wash your skin with warm water.
Don’t use perfume, perfumed soaps or lotions on the area as it can irritate the skin.
Pat your skin dry using a soft towel, do not rub.
Don’t shave the area being treated – speak to your radiotherapy team if you really need to remove the hair, it may be better to use a hair trimmer instead.
Don’t use any creams or dressings on the treatment area unless advised by your doctor or radiographer.

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.