Radiotherapy to the male pelvis. Information and advice for patients, relatives and carers

Transcription

1 Radiotherapy to the male pelvis Information and advice for patients, relatives and carers

2 Introduction This leaflet is a guide to radiotherapy treatment to the male pelvis and outlines a range of possible side effects and how to manage them. External beam radiotherapy involves a planning session followed by a series of daily outpatient treatments, Monday to Friday, usually over several weeks. The length of your course of treatment will be discussed with you, and decided by your clinical oncologist. This leaflet may not answer all of your questions, but it aims to answer the ones most commonly asked. Your clinical oncologist, radiographers, radiotherapy nurse and/or dietician will be happy to answer any further queries. Will I need an empty or full bladder for my treatment? If your bladder is being treated it may be necessary for you to empty it before treatment, daily. This allows the area treated to be as small as possible and aims to keep your bladder at a consistent size for treatment accuracy. The radiographers will explain this, if required, when you come in for your first visit. If your prostate is being treated you will need to have a comfortably full bladder for your treatment each day. This is because a full bladder will position some of the bowel out of the way of the treatment area, therefore reducing potential side effects. The radiographers can explain this in detail when you come for your first visit. If your bowel is being treated the radiographers and/or specialised radiotherapy nurse will give you instructions prior to your first visit. It will be necessary for you to follow these instructions daily.

3 What side effects will the treatment have? The side effects you experience will vary depending on the dose, duration and site of treatment. Side effects also vary from person to person depending on an individual s response. You will generally begin to notice side effects after 1 or 2 weeks (10 days) of treatment. These may continue until your treatment finishes and for 2 to 4 weeks after your treatment is complete. After this time they should gradually improve. It is important to remember that any treatment side effects are quite normal and most can be managed. The radiographers will monitor you throughout your course of treatment so please inform them of any side effects you are experiencing or if you have any other queries. The radiotherapy nurse will also see you once a week. Will the treatment make me tired? Tiredness may be experienced towards the end of treatment. This is usually a combination of travelling to and from the radiotherapy department, a side effect of the treatment and coping with your diagnosis as well as continuing with a normal life. It is advisable to rest as often as necessary and to keep yourself well hydrated. It may also be beneficial to do some gentle exercise such as walking. What kind of skin reaction will I get? You may notice some skin changes in the area being treated. After about two to three weeks, the skin may become pink/red and feel itchy and warm. Below are guidelines to caring for your skin during radiotherapy, but please talk to your radiographers, radiotherapy nurse or clinical oncologist during treatment for further advice on how to care for your skin.

4 How do I care for my skin during radiotherapy? In line with national guidelines*, we recommend that you: Do: Wear soft, loose clothing, preferably made of natural fibres. Shower with lukewarm water. Use only unperfumed products such as Simple soap (bar) or Johnson s baby soap. Gently pat the treated area dry with a soft cotton towel. Use the moisturising cream provided which is gentle, unperfumed and will help to prevent skin dryness. Use this cream from the beginning of treatment twice a day. Smooth a little cream gently onto the treatment area. Do not rub it in vigorously. Avoid exposing the treated area to direct sunlight. If you have to be in direct sunlight, wear clothing that covers the treated area. It is useful to remember that some chemotherapy medications also make your skin more sensitive to the sun. Towards the end of your course of radiotherapy you will be advised regarding skincare post treatment. Do not: Take a long, hot bath. If you do take a bath, keep the water lukewarm rather than hot. Use any perfumed products (bath/shower products, deodorants, perfumes, etc.) on the treated area except those recommended. Rub or itch the treated skin as it will become quite fragile.

5 Hair loss Radiotherapy may make hair fall out, but only in the area being treated. No other body hair is affected. The hair should begin to grow back again within a few weeks of the treatment finishing but, for some, hair loss can be permanent. Bladder irritation Radiotherapy can cause inflammation of the lining of the bladder. You may find that you experience some of the following side effects: A need to pass urine often (frequency) A burning sensation when you pass urine (similar to cystitis) A feeling that you can t wait when you need to empty your bladder (urgency) Blood in your urine (haematuria) It is usually possible to reduce or control these side effects. Let us know if you have any problems passing urine. The radiotherapy nurse may give you a urine test to make sure you haven t got an infection. Medicines such as anti-inflammatory drugs, antibiotics and painkillers can be prescribed if needed. The following may help: Avoid caffeine. This is in tea, coffee, cola and some painkillers. Caffeine stimulates the nerves of the bladder and can increase the severity of some of the side effects of treatment. Avoid alcohol. Alcohol may also make symptoms worse for some people.

6 Aim to drink the normal recommended amount of fluids. This is approximately two litres of liquid a day. You may be tempted to drink less, so your bladder does not fill up so quickly. However, this can make symptoms worse as the urine becomes more concentrated and irritates the bladder lining. Just can t wait card If you need to go to the toilet more often, or feel that you can t wait when you do want to go, you can get a card or a key to show to staff in shops, pubs and other places. The card allows you to use their toilets, without them asking awkward questions. You can get the cards from the Bladder and Bowel Foundation, or the keys from Disability Rights UK (Radar National Key Scheme). Diarrhoea If the radiotherapy area includes the small bowel, this may cause inflammation and irritation of the bowel. You may experience loose stools and cramp like pains in your abdomen. Radiotherapy to the rectum may make you feel that you need to open your bowels. Occasionally, the radiotherapy may cause some bleeding from the back passage. If you already had diarrhoea prior to starting treatment, it may make the problem worse. We can give you advice and may prescribe anti diarrhoea medicines (such as Imodium) to help control it. It is helpful to drink plenty of fluids to replace those lost through diarrhoea. The dietician can give you advice about your diet, which may also help reduce diarrhoea. Pain on ejaculation Some men experience a sharp pain when they ejaculate. This happens because the radiotherapy can irritate the tube that leads along the penis from the bladder (the urethra). The pain should ease off a few weeks after treatment finishes. If you are having

7 external beam radiotherapy treatment, it is fine to continue with your normal sexual relationships. Infertility Pelvic radiotherapy may cause you to become infertile. If you have any concerns regarding this, please discuss it further with your clinical oncologist as sperm banking may be an option for some individuals. Contraception During treatment it is advised that you use contraception as the sperm that you produce may still be fertile but could be damaged. This could cause abnormalities in a child if conceived soon after radiotherapy. It is recommended that you use contraception for a period of time after treatment. Please discuss this further with your clinical oncologist. After radiotherapy treatment has finished Radiotherapy has a cumulative effect. The side effects will begin to peak 7 to 10 days after your treatment has finished and will then start to improve. It is important that you continue with your prescribed care routine until the effects have settled. Most side effects should improve within four weeks of finishing treatment. Continue to rest as necessary, do some gentle exercise and aim to get back to a normal life again. You will have follow up appointments and scans with your clinical oncologist following treatment; however it may be some time until you will know the full benefits of your course of treatment. Your clinical oncologist will have explained this previously. If you have any concerns, or need advice or support, please contact your clinical oncologist, radiographers, radiotherapy nurse or dietician.

8 * SCoR, Skin care advice for patients undergoing radical external beam megavoltage radiotherapy. 10 February Available from: [Accessed 11 May 2015] The London Radiotherapy Centre at Guy s & St Thomas Borough Wing, Lower Ground Floor Guy s Hospital, Great Maze Pond London SE1 9RT T: / 7511 The London Radiotherapy Centre at University College Hospital Basement Level, UCLH Tower Euston Road London NW1 2BU T: / JR