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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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This information is about the use of radiotherapy to treat children with cancers in the abdomen (tummy) and pelvis. We have separate information for children having radiotherapy to the chest area| or to the head and neck|.
Radiotherapy can be a worrying experience for both children and their parents, but understanding what it involves can help to reduce your anxiety. It is helpful to read this information alongside the Macmillan/CCLG booklet A parent's guide to children's cancer|, which contains more information about children's cancers, diagnosis, treatment and support services.
Watch the 'One of a Kind' video|
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 the cancer cells in one area of the body, while doing as little harm as possible to normal cells. The treatment is given in the hospital radiotherapy department, normally as a series of short daily sessions.
The treatments are usually given from Monday–Friday, with a rest at the weekend. Each treatment takes about 10–15 minutes. Your child’s doctor will discuss the treatment and possible side effects with you. The length of time that the treatment is given for will depend on the type of your child’s tumour, but may last between 2–6 weeks.
In order for radiotherapy to be as effective as possible, it must be carefully planned.
Before planning starts, your child will be assessed to make sure they're able to cope with treatment and the way it's given. The assessment will either be made when your child first meets the doctor who plans the radiotherapy (the clinical oncologist), or on their first visit to the radiotherapy department. For treatment, 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.
A hospital play specialist, paediatric specialist radiographer, nursery nurse, or specialist nurse may spend some time with your child to help them prepare for radiotherapy. Through fun and play, they will help explain the treatment to your child. This can help reduce any fear or worries that they may have. Many parents are surprised at how cooperative their child can be during their treatment, once they have been given plenty of time to prepare with the hospital play specialist.
If your child can’t lie still for long enough, or would find it difficult to be in the treatment room alone, they can still have radiotherapy but will need to have a daily general anaesthetic. Most children under the age of three will need an anaesthetic; most aged four or over will not.
If at all possible, the radiotherapy will be given without an anaesthetic. For this reason, several visits to the radiotherapy department may be needed for preparation with the hospital play specialist, or nursery nurse, before radiotherapy planning begins. You may be given games and exercises to play with your child at home, to help them overcome any fear or anxieties they may have, and to familiarise them with what radiotherapy involves.
Treatment planning may take a few visits. On your child’s first visit to the radiotherapy department, they may have a CT scan or lie under a machine called a simulator. The CT scanner, or simulator, takes x-rays of the area to be treated. Treatment is planned by a cancer specialist (clinical oncologist). Marks may be drawn on your child’s skin to help the people giving the treatment (radiographers) 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.
Radiotherapy staff are experienced in treating children and can offer you help and support.
At the beginning of each radiotherapy session, the radiographer 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 radiographer, who will be watching from the next room, over a communication system. You can stay with the radiographer, 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.
Radiotherapy is not painful, but your child has to lie completely still for a few minutes while the treatment is being given. If your child is having their 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. You can stay with your child until they are asleep.
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.
The immediate side effects of radiotherapy are usually very mild:
Your child may feel very tired| while they're having the treatment and for a few weeks afterwards. Their energy levels may take a few months to get back to normal once treatment has ended.
Your child may lose their appetite|. It may be useful for them to have frequent small snacks throughout the day, rather than large meals.
Radiotherapy to some parts of the body can sometimes affect bone marrow|. This is where the different types of blood cells are produced. 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 (a condition called anaemia), they may feel very tired and lack energy.
Radiotherapy is less effective if the number of red blood cells is too low, so if your child is anaemic and has a haemoglobin level (Hb) of less than 10 they may need a blood transfusion|.
Only the treated area will be affected by local side effects and your child is unlikely to experience all the side effects listed below.
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 their skin type and the area being treated. 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 is being treated and the dose of radiotherapy being given. You may be asked not to wash the treatment area at all while your child is having treatment. Alternatively, you may be asked to wash the area only with warm water, and then to gently pat it dry with a soft towel. You could also dry the skin with a hairdryer on the coolest setting. Try not to rub the area, as this may make it sore.
It's important not to use soaps or talc on the treated area of skin. Hospital staff may suggest that you gently apply unperfumed moisturisers, such as E45 cream or aqueous cream. Always check before applying anything to your child’s skin.
These restrictions apply only to the affected area; the rest of your child’s skin can be treated normally. Their skin may peel after the redness has faded, but it should heal quickly. Skin reactions usually settle between 2−4 weeks after the radiotherapy has finished, but the treatment area may remain slightly darker than the surrounding skin.
Loose-fitting clothes, preferably in natural fibres (like 100% cotton) rather than man-made materials, are more comfortable for your child and less irritating to the skin.
Because the 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 against the sun. Even after this time the skin will be delicate, so extra care should be taken. Your child should use a sunscreen of at least factor 30. It's important to remember that their skin can burn, even through clothing, if they're in intense sunlight for a long time.
It's fine for your child to swim as soon as any skin reaction has settled down, usually within a month of finishing treatment. But if they're swimming outdoors, they should not stay in the water too long and should use a waterproof sunblock.
Diarrhoea| is a fairly common side effect of treatment to the abdomen. Your child may also have stomach cramps and a windy tummy. Your child’s specialist can prescribe medicines to control diarrhoea. It's important that your child drinks lots of fluid. The diarrhoea may continue for some weeks after the treatment. As well as being unpleasant, diarrhoea can make your child feel weak and tired. If it continues, and doesn’t seem to be getting any better, contact the radiotherapy department or your child’s doctor for further advice.
The skin around the back passage (anus) may become irritated by the radiotherapy if the area being treated is in the lower pelvis. Sometimes, after radiotherapy to the pelvic area, there may be a mucous-like discharge, or bleeding, from the back passage. Let your specialist know if your child has any of these problems.
Some children feel sick (nausea), and sometimes they may actually be sick (vomit), during radiotherapy treatment to the abdomen or pelvis. Tell your specialist if your child experiences any nausea or vomiting| as they can prescribe anti-sickness drugs (anti-emetics). These drugs are usually very successful. Any feeling of sickness usually stops once treatment is over.
These may occur as a result of diarrhoea and nausea. At times, your child may not feel like eating|. They may find it easier to eat little and often, having small, more frequent meals or snacks, rather than larger meals at set times. High-calorie drinks, which your doctor can prescribe, can be used in place of meals. If eating becomes a problem for your child, the dietitian or your specialist can advise you about nutritional supplements.
Occasionally, if your child continues to lose weight, it may be necessary for them to spend a short time in hospital so that they can be fed in special ways. Liquid food can be given through a central line, which is inserted into a vein in their chest, or by a tube passed through their nose and into their stomach (a naso-gastric or NG tube) until they are able to eat properly again. Staff can explain what this involves, and will include you in decisions about the best way to feed your child.
The bladder can become inflamed (cystitis) if radiotherapy is given to the pelvic area (usually after several treatments have been given). Your child may tell you that it ‘burns’ or ‘stings’, or is sore when they pass urine. You may notice that they need to pass urine more than usual. It's important that your child drinks plenty of fluids as this can help to ease the discomfort.
Some children find that drinking cranberry juice or lemon barley water helps to reduce symptoms. If necessary, medicines may be given. Your child may also have their urine checked regularly to make sure that they don't have an infection.
Radiotherapy given directly to the ovaries| (where eggs are stored) or testicles| (where sperm is made) is very likely to cause infertility|. Radiotherapy to parts of the body near the testicles and ovaries, including the lower parts of the spine, may also have an effect. However, boys who have reached puberty may be able to bank sperm before treatment.
Radiotherapy given to the womb or a nearby area can affect fertility. For example, it can make it more difficult for the womb to support a growing baby during pregnancy. There may be a higher risk of miscarriage, or the baby may be born small, or prematurely.
It can be very distressing to think that your child may not be able to have children in the future. Your child may also find this difficult to cope with, either now or in the future as they move towards adulthood. The staff at the hospital can discuss this with you, and the organisations listed below can give you emotional support.
You may find our booklet Relationships, sex and fertility: for young people affected by cancer| useful.
Radiotherapy can cause some other long-term side effects|, which may start gradually, months or sometimes years after the treatment. With time, the effect of radiotherapy to any growing tissues may become more noticeable.
If only one side of the abdomen or pelvis is irradiated (treated with radiotherapy) you may notice some asymmetry (unevenness) in the muscles. But the degree of asymmetry depends on the age of the child at the time of treatment and the dose of radiotherapy. If the spine is irradiated there may be some loss of potential height growth. Very occasionally radiotherapy to the kidney can cause kidney problems later in life.
While these possible long-term effects sound alarming, it's important to remember that not all children will develop them. Your child’s doctor or nurse can discuss this with you in detail.
Your child will have regular check-ups|, in the children’s (paediatric) or adolescent 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 face. Knowing that they also 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 can't address here all of the feelings that you may have. However, the booklet A parent's guide to children's cancer talks about the emotional impact of caring for a child with cancer, and suggests sources of help and support.
This information has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.