Chemo-Radiotherapy to the Oesophagus (Gullet)

Transcription

1 Chemo-Radiotherapy to the Oesophagus (Gullet) Patient Information

2 Introduction This information describes your future treatment with chemotherapy and radiotherapy for cancer of the oesophagus (known also as cancer of the gullet or oesophageal cancer). Please read it carefully and if you have any questions do not hesitate to contact your clinical nurse specialist or radiographer at the hospital. There are contact numbers at the end of this leaflet if you wish to discuss any aspect of your treatment. Agreeing to treatment Your specialist team of doctors has recommended that the best course of treatment for your cancer is a combined treatment using chemotherapy and radiotherapy (chemo-radiotherapy). You will need to sign a consent form stating that you agree to accept the treatment and that you have been informed of the risks and benefits. What is chemotherapy? The word chemotherapy comes from two words: chemical and therapy. Chemotherapy literally means drug treatment or anti cancer treatment. The aim of chemotherapy is to damage cancer cells so that they cannot grow and reproduce. Normal cells can also be damaged during chemotherapy, which can result in side effects. These cells can generally repair themselves more effectively than cancer cells. Treatment may involve a combination of cancer drugs and can be given with radiotherapy depending on the type of cancer you have. What is radiotherapy? Radiotherapy is the use of radiation (X-ray treatment) to treat cancer. A machine is used to direct high-energy rays at the cancer. Radiotherapy aims to destroy the cancer cells in the treated area. Although healthy cells are also affected, which can result in side effects, they can generally repair themselves more effectively than cancer cells. What are the risks and benefits of chemo-radiotherapy? The aim of this treatment is to shrink your tumour and cure your cancer. However, it is not possible to be sure of a cure and the success of the treatment differs from patient to patient. This is something you should discuss with your consultant in relation to your own personal case. This treatment may also reduce symptoms you are presently experiencing (e.g. difficulty swallowing). Your consultant will have discussed other possible treatments with you and also what will happen if you do not have treatment. If you do not have treatment, your cancer will continue 1

3 to grow and you can discuss how this will affect you both in the short and long term. What does chemo-radiotherapy involve? Chemo-radiotherapy treatment is undertaken at Queen Elizabeth Hospital Birmingham. The treatment lasts for between five and five and a half weeks in total. The radiotherapy is given once a day (Monday Friday) for a total of 25 or 28 visits and takes on average 15 minutes per session. It is combined with chemotherapy during week one and week five of treatment. The timetable for treatment is as follows: Week 1: five days chemotherapy and radiotherapy as an inpatient. Week 2: five days radiotherapy only, as an outpatient if possible. Week 3: five days radiotherapy only as an outpatient, if possible. Week 4: five days radiotherapy only as an outpatient, if possible. Week 5: five days chemotherapy and radiotherapy as an inpatient. Week 6: three days of radiotherapy only as an outpatient, if possible (for those having 28 treatments). The chemotherapy uses a combination of drugs and is given into a vein by a drip over a period of five days (we will offer you specific information on your drugs when you see your consultant). It usually takes five days to complete this chemotherapy and you will be admitted to one of the oncology wards. Before you start your combined treatment you will need to visit the hospital for the following tests: Blood tests, including kidney tests. Electrocardiogram (ECG) this is a test which measures the electrical activity of your heart. CT (Computerised Tomography) scan this is to plan the radiotherapy treatment required. You may need to make more than one visit to the radiotherapy department before your treatment starts. A blood test will be taken each time you come to the hospital for chemotherapy to make sure your results are normal before the chemotherapy is given. 2

4 Planning radiotherapy Everyone with cancer is different and in order to personalise your treatment to your needs you will need to attend the hospital for a CT scan. CT scan uses special X-ray equipment to obtain many images from different angles. A computer programme joins the images together to show detailed pictures of the inside of the body. While you are on the scanner, you will be asked to remove the clothes in the area to be scanned before the scan. You may also be asked by the radiographers to swallow a liquid, called a contrast agent, before the scan. Small, permanent ink marks (tattoos) will be used to identify the area to be treated with radiotherapy. These look like little black dots and are barely noticeable but are important to ensure you are always in the correct position for your treatment. What are the side effects of chemo-radiotherapy? There are two types of side effects that occur with chemo-radiotherapy. There are early term side effects (occurring during or just after treatment) and late term side effects (occurring some time after treatment has finished). The common side effects are listed below: Early side effects These generally increase during the treatment and peak at the end of treatment or the week after treatment has finished: Chest pain you may experience some mild chest pain during the treatment. This usually settles down quite quickly and is mild in nature. If your chest pain is severe or does not settle down quickly, ring the chemotherapy emergency number (given at the back of this leaflet) immediately or ask to speak to the Oncology Registrar on call. If you have major concerns and can not speak to the Registrar quickly, dial 999 for an ambulance. Cough sometimes you may start to cough and bring up phlegm during the course of treatment. You must let the medical staff know if this becomes troublesome or the phlegm becomes discoloured or blood stained. Swallowing problems and sore mouth the lining of the mouth and gullet may become irritated during treatment. You may feel as if you have a lump in your throat when you swallow. Your oncologist can prescribe medication to ease this so let the nursing staff looking after 3

5 you know as soon as swallowing becomes difficult. Cool drinks, ice cream and jellies may help soothe your throat. It is advisable not to eat spicy foods or take hot drinks. You may need a soft or liquidised diet for a short time. You can be put in contact with a dietitian during your treatment if you find you are eating less. Occasionally if you cannot swallow at all, a temporary feeding tube will need to be inserted either through your nose or into your bowel which requires an operation under general anaesthetic. If this happens, you will need to stay in hospital to establish a feeding pattern. Low blood count chemotherapy can cause some damage to the bone marrow, causing a lowering of the white blood cells (which help fight infection) and platelets (which help with the clotting of the blood). This may result in an increased risk of infection, bruising or bleeding. Your oncologist will check your blood count regularly and treat any problems as they occur. Ring the emergency chemotherapy contact number if you get a fever (temperature over 38 degrees centigrade) or notice unusual bleeding or bruising. This may be a sign of an infection which will require antibiotics. Tiredness radiotherapy and chemotherapy can make you feel tired. This can last for a number of weeks after the treatment is finished. It is best to take it easy and don t push yourself too hard. Rest when you feel tired. Skin skin in the treated area may become slightly pink or red, may itch or become dry. You may shower during your treatment but do not have the water too hot or bathe for too long. Use a simple unperfumed soap and avoid rubbing the skin. It is best to pat the skin dry with a soft towel. If you have concerns about your skin, talk to the radiographers or chemotherapy nurses. Men with hairy chests may notice the hair falling out in the treated area but it will generally grow back after the treatment is finished. This can happen two to three weeks after the treatment starts. Nausea or vomiting chemotherapy and radiotherapy can make you feel nauseous, particularly if the lower portion of your gullet is being treated with radiotherapy. You will be given anti-sickness drugs (antiemetics) to take before the chemotherapy treatment. Ginger also has natural anti-sickness properties and is available in a variety of forms such as biscuits, sweets or herbal teas. Your doctor may 4

6 choose to use steroids as part of your treatment and these will be explained to you at the start of the course. Other side effects these can include drying and flaking of the hands and feet and diarrhoea. Your doctor will discuss with you the best way to treat these problems if they occur. The early side effects usually settle down about four weeks after finishing the treatment but this can vary from person to person. Late side effects These generally occur weeks to months after treatment finishes and can include: Breathlessness radiotherapy may cause lung scarring (fibrosis). Although every effort is made to minimise the radiation dose to the lungs, sometimes you will notice a slight increase in shortness of breath. If this becomes a problem please discuss this with your oncologist or GP as sometimes medication or breathing exercises can help. Narrowing of the gullet scarring caused by the radiotherapy may cause a change in the gullet. Sometimes you may need an endoscopic procedure to gently stretch (dilate) the narrowed area. This can be performed during an outpatient appointment. Other side effects normal tissue may be affected by the chemotherapy and radiotherapy including the heart, kidneys and hearing (by reducing hearing of high pitched sounds). The risk is low and your doctor will discuss this with you on an individual patient basis. What can I do to help myself? It is important that you maintain your calorie intake. Eat small frequent meals or snacks throughout the day. You may need nutritional drinks if you are losing weight or you are concerned about your eating. You will be able to see a specialist dietitian during your course of treatment who can give you advice about. It is important to take things easy during your treatment. Do not push yourself too hard it will only mean that your body needs extra time to recover. 5

7 Useful contacts The following people will be able to support you through your course of treatment: 1. Chemotherapy emergency number: 2. On-call oncology registrar: 3. Clinical nurse specialist team: 4. Upper gastro-intestinal dietitian: 5. Chemotherapy nurse: It is important that you make a list of all medicines you are taking and bring it with you to all your follow-up clinic appointments. If you have any questions at all, please ask your surgeon, oncologist or clinical nurse specialist. It may help to write down questions as you think of them so that you have them ready. It may also help to bring someone with you when you attend your outpatient appointments. Local support groups Please visit on our website for details of local support groups: Local sources of further information You can visit any of the health/cancer information centres listed below: Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone:

8 Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon, West Bromwich B71 4HJ Telephone: Fax: University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: Walsall Primary Care Trust Cancer Information & Support Services Challenge Building Hatherton Street Walsall WS1 1YB Freephone: About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust Sandwell and West Birmingham NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust We acknowledge the support of Macmillan in producing this information. Pan Birmingham Cancer Network 2010 Publication Date: June 2010 Review Date: June