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Radiotherapy| treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. It will cure most people whose cancer has not spread outside the larynx.
In people with larger tumours, radiotherapy may be given after removal of the larynx| (laryngectomy). In this situation, the aim of the treatment is to destroy any cancer cells that may have been left behind after the surgery, particularly in the lymph glands in the neck.
Radiotherapy treatment is usually given as a series of short, daily treatments in the hospital radiotherapy department. The treatments are normally given from Monday to Friday with a rest over the weekend. However, sometimes you may also have treatment at the weekend, or more than one treatment each day. It’s important to follow the treatment plan and avoid any unnecessary gaps in your course of treatment.
Radiotherapy treatment usually lasts from 3–7 weeks, depending on the type and size of the cancer. Your radiotherapy doctor will discuss your treatment plan and any possible side effects with you.
Radiotherapy is carefully planned to make sure it is as effective as possible. The radiotherapy is aimed very precisely at the area of the larynx. It’s important that you are able to lie still, in exactly the same position, each time the treatment is given. To help you to do this, a special mask (or shell) of your head and shoulders is made. The shell fits over your head and neck and is then fixed to the treatment couch. This holds you firmly in the right position.
The mask is made on one of your first visits to the radiotherapy department. It’s made in the mould room of the radiotherapy department by a mould technician or radiographer (the person who gives the radiotherapy treatment). The process of making the mask can vary slightly between hospitals. It usually takes around 30 minutes.
There are two ways to make a mask. One technique uses wet plaster bandages and the finished mask is made of perspex (a type of plastic). The other way uses a type of mesh plastic, which is moulded to fit the shape of your face.
Our radiotherapy section has more information about radiotherapy masks|.
Your treatment will be planned by a clinical oncologist (radiotherapy and chemotherapy doctor). You may need to make a few visits to the radiotherapy department to plan the radiotherapy. You will have a CT (computerised tomography) scan| taken of the area to be treated. This scan takes lots of images from different angles to build up a three-dimensional picture of the area. At the same time, therapy radiographers will take measurements from you which are needed for treatment planning.
You will need to wear the mask for the planning sessions. You won’t be able to speak while you have the mask on. However, the radiographers will tell you how to signal to them if you want to communicate with them.
Marks are drawn on the mask (or sometimes on your skin) to help the radiographer to position you accurately and to show where the radiotherapy rays will be directed. If the marks are drawn on your skin they must stay there throughout your treatment, but they can be washed off once the course of treatment has ended.
Once the scans and measurements have been taken, your doctors and a team of medical physicists will use special computer programmes to work out the exact dosage of your treatment. The planning process may take a week to ten days to complete, and then the actual treatment can start.
Before each session of radiotherapy, the radiographers will position you carefully on the couch with the mask fitted. They will make sure that you are comfortable. The treatment only takes a few minutes. During this time you will be left alone in the room. However, you can signal to the radiographers, who will watch you on a television monitor from the next room. You have to lie still while the treatment is given, but you won’t feel the radiotherapy. It’s similar to having an x-ray.
Before you start your treatment, your doctor will explain the likely side effects and how they can be controlled. Radiotherapy to the larynx can cause the following side effects:
During radiotherapy treatment the tissues in your throat will become inflamed. Sometimes this inflammation leads to swelling which can lead to breathing problems. If this happens it’s important that it’s treated quickly. If you develop any breathing difficulties, or your breathing sounds different, then let a doctor or the hospital know as soon as possible.
The skin at the front of your neck will become red or darker. It will also become sore and feel like sunburn. The changes in the skin begin about two weeks after the treatment has begun and may continue until about 2 to 4 weeks after the treatment has ended. Sometimes the skin may peel or crack.
The staff in the radiotherapy department will advise you how to look after your skin during the treatment. They may prescribe creams or lotions for you to use if your skin becomes very sore. If the skin on your neck peels you may need a dressing on the area. This can be done by a community nurse or a practice nurse at your GP’s surgery.
Men should not wet-shave during radiotherapy but can use an electric razor.
Some chemicals in soaps, creams, perfumes or beauty products can make your skin more sensitive to the effects of the radiotherapy. You should not use any soap, creams or lotions on the skin in the treatment area without first asking the radiotherapy staff. Avoid using perfumes and aftershave until the skin has healed. Even once the skin has recovered it may always be slightly darker than before.
Radiotherapy to the throat does not affect the hair on your head, but men lose their beard (usually permanently) from the areas of skin which are treated.
The lining of your throat will become sore and inflamed during the treatment. This can make it difficult to swallow. Your doctor can prescribe painkillers to ease this, which can be taken as a liquid. You will be given advice on foods which are easy to swallow. Most people manage to eat a soft diet until the soreness has settled, which usually occurs within a few weeks after the treatment has finished.
Some people find that their throat becomes too sore to eat or drink easily. If this happens, a thin tube (nasogastric tube) is passed up their nose and down into the stomach. A special liquid diet prescribed by a dietitian can then be given through the tube. Sometimes instead of a nasogastric tube a gastrostomy tube may be used instead. This is a feeding tube that passes directly into your stomach through the skin near your waist. PEG (percutaneous endoscopic gastrostomy) and RIG (radiologically-inserted gastrostomy) tubes are types of gastrostomy tubes that may be used.
Our nutritional support| section has more information about nasogastric, PEG and RIG tube feeding.
Occasionally radiotherapy treatment to the larynx can affect the salivary glands, so that less saliva is produced.
This means the lining of your throat or mouth may become dry| during treatment. Sometimes the dryness can continue for a long time after the treatment has finished. You may notice a feeling of sticky mucus in the throat, which will gradually clear up. You may also have a persistent tickly cough for a time.
Your voice may already be hoarse before you start the treatment. It’s likely to become more hoarse (or may even be lost completely) during the radiotherapy. Your voice will then gradually improve and get stronger over the following weeks and months after treatment. Sometimes it’s helpful to see a speech and language therapist, who can advise you on voice exercises to speed up the recovery. Your doctor or specialist nurse can arrange this for you.
Some people find that they lose their appetite. If you don’t feel like eating, your doctor, or a dietitian can prescribe nutritious, high calorie drinks to supplement or replace your meals until your appetite comes back.
Our diet| section has some helpful hints on how to eat well when you are feeling ill, or if you find swallowing painful.
The loss of appetite may be at its worst towards the end of the course of treatment and during the first couple of weeks after your treatment has finished. It can be mild or more troublesome, depending on the dose of radiotherapy given and the length of your treatment. Your doctor will let you know what to expect.
Your sense of smell and taste may become dulled or changed during treatment and for a few months afterwards.
Radiotherapy often causes tiredness (fatigue)|. It’s helpful to get as much rest as you can, especially if you have to travel a long way for treatment each day. The tiredness may last many months after the treatment has ended.
Radiotherapy does not make you radioactive and it’s perfectly safe for you to be with other people, including children and pregnant women, throughout your treatment.
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