Radiotherapy for children with cancer in the chest area
Radiotherapy is sometimes used to treat children with cancer in the chest area. We have separate information for children having radiotherapy for head and neck cancer, or to the abdomen and pelvis (tummy) area.
Radiotherapy can be a worrying experience for both children and their parents, but understanding what it involves can help reduce your anxiety.
It's helpful to read this information our section on children’s cancers, which contains more information about cancers in children, their diagnosis and treatment, and the support services available. Our information about radiotherapy for people of all ages may also be of interest.
We hope this information answers your questions. If you have any further questions, you can ask a nurse, radiographer or doctor involved in your child's treatment.
Animation for children about radiotherapy
If your child is about to have radiotherapy, it may help to watch the short video ‘One of a Kind’, produced by Aardman Animations and funded by a partnership of eight charities. The animation shows children what to expect on a visit to the radiotherapy department. A young girl explains what happens when she goes for treatment. The images are friendly and the words are simple and easy to understand. Perhaps watch it yourself first to prepare for any questions your child may have and then have a look together.
Radiotherapy treats cancer by using high-energy rays to destroy cancer cells in one area of the body, while doing as little harm as possible to normal cells. The treatment is painless and is given in the hospital radiotherapy department, normally as a series of short daily sessions.
The treatments are usually given from Monday to Friday, with a rest at the weekend. Each treatment takes only a few minutes. Your child’s doctor will discuss the treatment and possible side effects with you. The number of sessions will depend on the type of tumour your child has, but treatment may last for several weeks.
In order for radiotherapy to be as effective as possible, it must be carefully planned.
Preparing your child
Before planning starts, your child will be assessed to make sure they're able to cope with treatment and the way it's given. This will be done either when your child first meets the doctor who plans the radiotherapy (clinical oncologist), or on their first visit to the radiotherapy department.
To help your child prepare for radiotherapy, a hospital play specialist, paediatric specialist radiographer, nursery nurse, or specialist nurse may spend some time them. Through fun and play, they will help explain the treatment to your child, and this may take several visits. You may be given games and exercises to play with your child at home. This is to help them overcome any fears or anxieties they may have, and to get used to what radiotherapy involves.
Many parents are surprised at how cooperative their child can be during radiotherapy, once they’ve been given plenty of time to prepare with the hospital play specialist.
For planning and for the treatment itself, your child will need to be able to lie still in a particular position for a few minutes, and feel comfortable being alone in the treatment room. If your child can’t lie still for long enough, or finds it difficult to be in the treatment room alone, they will need a daily general anaesthetic to have radiotherapy. Most children under the age of three will need an anaesthetic; most aged four or over will not need it.
Your child’s treatment is planned by a cancer specialist (clinical oncologist). Treatment planning may take a few visits and will involve your child having a CT scan to create detailed images of the area to be treated. Marks may be drawn on your child’s skin to help make sure treatment is given to exactly the right area each time. Sometimes, small permanent dots (tattoos) are also used. Your doctor or specialist nurse will explain this process to you.
At the beginning of each radiotherapy session, the radiographers will position your child carefully on the couch, and make sure they're comfortable. During treatment, your child will be alone in the room, but they will be able to talk to the radiographers (who will be watching from the next room) over a communication system. You can stay with the radiographers, so that you can see your child and talk with them. Music, story tapes or CDs can be played for your child, or you can read stories to them.
If your child is having treatment under a general anaesthetic, they can't eat or drink for at least four hours before being given their anaesthetic. Because of this, your child will usually have a morning appointment. The anaesthetic is given in the radiotherapy department by an anaesthetist, who is trained in giving anaesthetics to children.
Older children may take a while to get used to the size and sound of the machines, but this should become easier once they get to know the staff and surroundings.
Possible general side effects of radiotherapy
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The immediate side effects of radiotherapy are usually very mild.
Tiredness is a common side effect during radiotherapy and for a few weeks afterwards. It may take a few months for your child’s energy levels to get back to normal once treatment has ended.
Loss of appetite
Your child may lose their appetite. It may be easier for them to have small, frequent snacks throughout the day, rather than main meals.
Effect on bone marrow
Radiotherapy can sometimes affect bone marrow (where the different types of blood cells are made). If this is likely to happen in your child’s case, they will have regular blood tests during treatment to check their blood cell levels (blood counts). If their red blood cell levels are low (anaemia), they may feel very tired and lack energy.
Radiotherapy may be less effective if the number of red blood cells is too low, so if your child is anaemic, they may need a blood transfusion.
Possible local side effects during radiotherapy
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Only the treated area will be affected by local side effects, and your child is unlikely to experience all the side effects listed here.
Effects on skin
Some children develop a skin reaction, similar to sunburn, while having radiotherapy. This normally happens after 3-4 weeks. In children with pale skin, the skin in the treatment area becomes red and sore, or itchy. In children with dark skin, it becomes darker. The severity of the reaction depends on a number of factors, and some children have no skin problems at all. The radiographers will look for these reactions, but you should also let them know if your child feels any soreness.
Radiotherapy staff will advise you on how to look after your child’s skin in the treated area. This varies according to the part of the body being treated and the dose of radiotherapy being given. You may be asked to wash the area only with warm water, and then to gently pat it dry with a soft towel. Try not to rub the area, as this may make it sore.
It's important not to use soaps or talcum powder on the treated area of skin. Hospital staff may suggest that you gently apply unperfumed moisturisers. Always check with your child’s doctor, nurse or radiographer before applying anything to your child’s skin.
These restrictions only apply to the affected area; the rest of your child’s skin can be treated normally. The skin may peel after the redness has faded, but it should heal quickly. Skin reactions usually settle down 2-4 weeks after the radiotherapy has finished, but the treated area may remain slightly darker than the surrounding skin.
Loose-fitting clothes, preferably made of natural fibres (such as 100% cotton) rather than man-made materials, are more comfortable for your child and less irritating to the skin.
Taking care in the sun
Because skin in the treated area is very sensitive, it should not be exposed to the sun or cold winds. It's very important to cover the treated area if your child goes out in strong sunshine, for at least the first year after their radiotherapy. They should wear clothing made of cotton or natural fibres that have a closer weave and offer more protection.
The treated skin will always be sensitive to sun damage, so extra care should be taken. Your child should use a suncream of at least factor 30. It's important to remember that skin can burn in strong sunlight, even through clothing. We have more information on taking care of your skin in the sun.
It's fine for your child to swim as soon as any skin reaction has settled down, which is usually within a month of finishing treatment. But if they're swimming outdoors in strong sunlight, they should use a waterproof sunblock and should not stay in the water too long.
Difficulty with swallowing
About 2-3 weeks (but sometimes only a few days) after radiotherapy to the chest has started, your child may tell you that their chest feels tight, making it difficult for them to swallow solid foods. This is a common reaction to treatment. It may help to try a soft, plain diet, supplemented by high-calorie drinks, which your child’s doctor can prescribe. They may also prescribe painkillers or liquid medicines for your child to take before meals, to make eating less uncomfortable. This difficulty usually gets better on its own in about 5-8 weeks.
Feeling sick (nausea) and being sick (vomiting)
Some children find that their treatment makes them feel sick, and sometimes they may actually be sick. This is most common when the treatment area is near the stomach. Tell your specialist if your child experiences any nausea or vomiting, as they can prescribe anti-sickness drugs (anti-emetics) to help. These drugs are usually very successful. Any feeling of sickness usually stops once treatment is over.
After radiotherapy to the chest, your child may have a dry cough and experience breathlessness. This may not occur until several months after the treatment. If you notice this, you should tell your child’s doctor, who may give treatment with steroids and possibly antibiotics.
Possible long-term side effects
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Radiotherapy can cause some long-term side effects, which may start months or sometimes years after treatment. These effects are difficult to predict and, unfortunately, when they do occur, they are permanent. We’ve given some examples of these below. Your child’s doctor will discuss with you in detail any possible long-term effects.
Effect on growth
With time, the effects of radiotherapy on growing tissues may become more noticeable. This may lead to asymmetry (unevenness) in the muscles or bones in the treated area. In girls, breast development may be affected. The degree of asymmetry depends on the age of the child at the time of treatment and the dose of radiotherapy given. If the spine receives radiation, there may be some loss of final height.
Effect on other organs
Radiotherapy to the lungs or heart may cause possible problems with these organs later in life.
Although these possible long-term effects sound worrying, it’s important to remember that not all of them will necessarily apply to your child.
Your child will have regular check-ups in the children’s (paediatric) or adolescents’ cancer clinic. The doctors will monitor them regularly for signs of any problems or long-term side effects.
As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. Knowing that they need radiotherapy treatment, which may cause side effects, can also be very difficult. You may have many different emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and part of the process that many parents go through at such a difficult time.
We cannot address all of the feelings you may have on this page. However, our section on living with cancer talks about the emotional impact of caring for a child with cancer and suggests sources of help and support.
Children’s Cancer and Leukaemia Group (CCLG)
The CCLG coordinates research and care for children and their parents. There are 21 CCLG specialist centres for the treatment of childhood cancer and leukaemia, covering all areas of the UK and Ireland. A map of the centres is on the website.
CLIC Sargent offers practical support, nationally, to children and young people with cancer and leukaemia, and to their families.
This fact sheet has been compiled using information from a number of reliable sources, including:
National Institute for Health and Clinical Excellence (NICE). Improving Outcomes with Children and Young People with Cancer - The Manual. August 2005.
Pinkerton, et al. Evidence-based paediatric oncology. 2nd edition. 2007. Blackwell Publishing.
Pizzo P, et al. Principles and Practice of Paediatric Oncology. 6th edition. 2011. Lippincott Williams & Wilkins.
With thanks to Dawn-Marie Davies, Paediatric Specialist Radiographer, and Dr Tina Foord, Consultant Clinical Oncologist.