Cancer Information Online

2008-03-15T22:05:00.000-07:00

It is long gap in posting new info. Again it stared now. Visit Cancer Information Online regularly.

Staff in the radiotherapy department

2007-08-28T10:00:00.000-07:00

Clinical oncologist

Although you will continue to be in the care of your GP during and after your radiotherapy, while you are having the treatment itself you will be under the care of a clinical oncologist. A clinical oncologist is a doctor trained in the use of radiotherapy and chemotherapy. The clinical oncologist will be responsible for prescribing and supervising your course of treatment.

You may see your oncologist before, during, and after your course of radiotherapy treatment, so that the effect of the treatment can be monitored. If you have any problems before or after your treatment, the nurses or radiographers can arrange an extra appointment for you.

If you are having chemotherapy as well as radiotherapy, this treatment may be supervised by your clinical oncologist or may be organised by a different doctor, called a medical oncologist. Medical oncologists specialise in chemotherapy treatment.

Medical oncologists and clinical oncologists work as part of a team. The team includes all the other health care staff who look after people having treatment for cancer. This multidisciplinary team will have regular meetings to co-ordinate and plan the care and treatment of their patients.

Radiographers

Radiographers are specially trained in using x-ray equipment. There are two main types of radiographer: therapy radiographers and diagnostic radiographers.

Therapy radiographers (also sometimes called radiotherapists) are the people who operate the machines that give you your radiotherapy treatment. They are highly trained in giving radiotherapy and in patient care.

Diagnostic radiographers use x-rays (including CT scans, mammograms and MRI scans) to diagnose illness – you may have x-rays or scans from time to time during and after your treatment to check the effect of your radiotherapy treatment.

Therapy radiographers work closely with your specialist and physicist to plan your treatment. Where possible, you will see the same radiographers throughout your course of treatment so you get to know each other quite well. They can give you help and advice about any aspect of your treatment, and you can discuss any of your concerns or anxieties with them. You can ask to be treated by a radiographer of the same sex as yourself, if you prefer.

Some radiographers, known as information radiographers, specialise in giving information to patients and their relatives.

Physicist

Working with the clinical oncologist is a physicist – a radiation expert – who will help to plan your treatment, assisting your specialist in decisions about the best way of giving the prescribed amount of radiation. The physicist is also responsible for maintaining the accuracy of the equipment used. Although you may meet the physicist at your initial planning appointment, they usually work behind the scenes.

Mould room technician

If you need to have a mould made of part of your body to keep it still during treatment, this will usually be done by technical staff in the mould room.

Nursing staff

Like hospital wards, the radiotherapy clinic has nursing staff – usually a sister or charge nurse and a team of nurses. They ensure that the clinic is running smoothly and look after any general needs you have, such as dressings and medicines. The nurses in the radiotherapy department can also give information and advice about the treatment and they give practical support.

Other members of the cancer support team

Social worker

Social workers can give advice about any non-medical problems that you may have. This includes practical and financial help: for example, some patients can claim travelling expenses and others may be eligible for a grant from a charity. Social workers can also give or organise counselling and emotional support for you and your family. If necessary they will refer you to local support services that can help you at home. You can ask to see a social worker if you think that this would be helpful.

Symptom control team (palliative care team)

Many hospitals have a symptom control team to give additional help and support for people whose symptoms or treatment are causing problems. There may be other staff, such as dietitians or physiotherapists, who can help with any specific questions you may have.

Counsellors

Counsellors are available in some hospitals. If you feel that speaking to a counsellor would be helpful, ask the staff looking after you to arrange an appointment. You can also contact the Cancer Counselling Trust.

Secretaries and clerical staff

The secretaries and clerical staff in the radiotherapy department help to keep the appointment system running smoothly.

Where do you have your radiotherapy treatment?

2007-08-28T09:51:00.000-07:00

Radiotherapy equipment is very complex and needs a lot of space, as well as support from specially trained staff, so radiotherapy departments tend to be in the larger regional and teaching hospitals. Often you will have your initial cancer treatment (such as surgery) at your local hospital and will then be referred to your nearest specialist cancer treatment hospital for your radiotherapy treatment.

Radiotherapy departments have varying types of equipment and are organised according to local needs, so they are run in different ways. While most of the information in this section is fairly general, and will apply to most departments, you may find that there are some differences at the hospital where you are treated.

You can usually have external radiotherapy as an out-patient, but if you are unwell, or having chemotherapy at the same time, you may need to stay in hospital and will be taken to the radiotherapy department each day from the ward.

If you are having internal radiotherapy, you may have to stay in hospital for a few days.

General side effects of radiotherapy

2007-07-16T05:31:00.000-07:00

While external radiotherapy can destroy cancer cells, it can also have an effect on some of the surrounding normal cells. The side effects that may occur are described in this section. It is important to remember that no person will have more than a few of them, and for many people they may be very mild.

As radiotherapy affects people in different ways, it is difficult to predict exactly how you will react to your treatment. Before you start your treatment, the staff will discuss with you any likely side effects of the particular treatment you are having. They can also give tips on how to deal with them and how they can be treated. Being aware of side effects in advance can help you to cope with any problems that occur.

Most side effects of radiotherapy disappear gradually once the course of treatment is over. However, the side effects may continue for a few weeks.

Tiredness

You may find that you feel very tired during your radiotherapy. This can often be made worse by having to travel to your treatment each day. Listen to your body, and if necessary, allow yourself extra time to rest, perhaps by taking a nap in the afternoons. It may help if you spread chores out over the week, sit down to do them, wherever possible, and accept any offers of help. Tiredness can be a problem for some months after your treatment has finished. See information on coping with fatigue.

Eating and drinking

As always during treatment of any kind, it is important to maintain a healthy diet and drink plenty of fluids. At times you probably won't feel like eating, or you may find that your eating habits change. It may be easier to have small snacks throughout the day rather than large meals. It is not unusual to lose a little weight during radiotherapy, but if you are having any problems with eating it is important to tell the radiotherapy staff. They can arrange for you to talk to the dietitian at the hospital. The section on diet and cancer also gives useful advice on eating.

Changes in your blood

Radiotherapy to some parts of the body can sometimes affect the bone marrow, which produces the different types of blood cells. If this is thought likely to happen in your case, you will have regular blood tests during your treatment to check your blood counts (the number of cells in your blood). If your blood counts are low, you may feel tired and 'run down'. If your blood count becomes very low (which is unlikely), it may be necessary to have a short rest from treatment so that your blood cell level can return to normal. You may also need to have a blood transfusion.

It is very important to let your doctors know if you feel very unwell, or if your temperature goes above 38oC (100.4oF), or if you start feeling cold and shaky.

Skin care

Some people develop a skin reaction, similar to sunburn, while having external radiotherapy. This normally happens after 3–4 weeks. People with pale skin may find that the skin in the treatment area becomes red and sore or itchy. People with darker skin may find that their skin becomes darker and can have a blue or black tinge. The amount of the reaction depends on the area being treated and the individual person's skin. Some people have no skin problems at all. Your radiographers will be looking for these reactions, but you should also let them know as soon as you notice any soreness or change in skin colour.

Do not use any creams or dressings unless they have been prescribed or recommended by specialist.

Occasionally, if your skin gets very sore, your treatment may have to be delayed for a short time to allow the area to recover.

Staff at your radiotherapy department will be able to give you advice on how to look after the skin in the treatment area. The care of the skin varies according to the part of the body that is being treated and the dose of radiotherapy that the skin is receiving.

You may be asked not to wash the treatment area at all while you are having treatment. Or, you may be advised to use only tepid water to wash the area (and not to soak too long in the bath). You can dry the skin by patting gently with a soft towel or using a hairdryer on the coolest setting. Do not rub the area as this may make it sore.

Soaps, talcs, deodorants and perfumes may also make your skin sore and should not be used. The staff at the hospital may suggest that you gently apply simple moisturisers, such as E45 cream or aqueous cream, to the area. After your treatment, simple soap and simple moisturisers are often recommended. Aloe vera cream or arnica cream can sometimes help the skin to heal. Always check with the radiotherapy staff before applying anything to your skin.

It is very important that any marks put on your skin to mark the treatment area are not removed. If the marks do fade or disappear, do not try to replace them yourself but let the radiotherapy staff know.

Men who are having radiotherapy to the head and neck should use an electric razor, rather than wet-shaving.

These restrictions apply only to the treatment area, and the rest of your skin can be treated normally. Your skin may peel after the redness has faded, but it should heal quickly. Changes in the skin usually settle down two to four weeks after the treatment has finished, but the area may stay slightly darker than the surrounding skin.

Avoiding the sun

Because the treated area is so sensitive it should not be exposed to the sun or cold winds. If you are having radiotherapy to the head or neck, try wearing a silk or cotton scarf when you go outside.

It is very important to cover the treated area if you go out in strong sunshine for at least the first year after your radiotherapy. Wear clothing made of cotton or natural fibres, which have a closer weave and offer more protection against the sun. Even after this time the skin will be more delicate, so extra care should be taken. Use a sun-screen (of at least factor 15) and wear a hat and a long-sleeved shirt. It is important to remember that you can burn even through clothing if you are out in hot sun for a long time.

You can swim as soon as any skin reaction has settled down, usually within a month of finishing treatment. However, if you are swimming out of doors, do not stay in the water too long, and remember to use a waterproof sunblock.

Clothing

Loose-fitting clothes, preferably in natural fibres rather than man-made materials, are more comfortable and less irritating to the skin. If you are having radiotherapy to your neck, avoid tight collars and ties.

Shoulder straps and bra straps can also cause irritation if they are rubbing against treated skin. If your breast area is being treated, you may be more comfortable not wearing a bra or wearing a cropped top or vest.

Smoking

Stopping smoking during and after radiotherapy is very worthwhile. Research has shown that it may make the radiotherapy more effective as well as reducing the side effects. It will also improve your general health and reduce your risk of developing other cancers.

Stopping smoking or even cutting down at such a stressful time can be very difficult, but do your best. If you want help or advice you can talk to your specialist, GP or a specialist nurse, who will be able to suggest ways of stopping. Organisations such as QUIT also offer advice and valuable support.

Complementary therapies

Complementary therapies can help to improve your quality of life and wellbeing and can sometimes help to reduce the side effects of radiotherapy. Many people find that complementary therapies or practices can help them to feel stronger and more confident in dealing with radiotherapy. These therapies can be used alongside conventional treatments and medicines.

Some complementary therapies, such as meditation or visualisation can be done by the person with cancer themselves and can reduce anxiety. Other therapies such as gentle massage can be carried out by relatives or carers and can help them to support the person with cancer.

Physical contact and touch can be among the most powerful forms of support for people who are faced with uncertainty, fear or pain, whether emotional or physical. Touching someone gently can express how much you care about them.

Some hospitals offer complementary therapies alongside conventional care.

These may include:

aromatherapy
colour and sound therapy
massage
relaxation, visualisation or guided imagery techniques
acupuncture.

Relaxation

Deep relaxation is a skill which can be learned. It can be used to:

release muscle tension
relieve stress
reduce tiredness and pain
improve sleep and peace of mind
regain control of emotions.

Relaxation is not simply 'taking it easy', but involves making time to reflect on problems or anxieties and, hopefully, develop a positive mental outlook.

There are several different relaxation techniques which can be self-taught from books or tapes. You can get these from your local library, bookshop and some chemists. Therapists and groups throughout the country also teach particular relaxation methods.

Side effects of radiotherapy to specific areas of the body
How radiotherapy might affect your sex life
How radiotherapy might affect your fertility
Your emotions and radiotherapy

Radiotherapy Treatment - Where do you have your?

2007-07-12T06:44:00.000-07:00

If you are having internal radiotherapy, you may have to stay in hospital for a few days.

Staff in the radiotherapy department

Clinical oncologist

Although you will continue to be in the care of your GP during and after your radiotherapy, while you are having the treatment itself you will be under the care of a clinical oncologist. A clinical oncologist is a doctor trained in the use of radiotherapy and chemotherapy. The clinical oncologist will be responsible for prescribing and supervising your course of treatment.

Radiographers

Radiographers are specially trained in using x-ray equipment. There are two main types of radiographer: therapy radiographers and diagnostic radiographers.

Therapy radiographers (also sometimes called radiotherapists) are the people who operate the machines that give you your radiotherapy treatment. They are highly trained in giving radiotherapy and in patient care.

Diagnostic radiographers use x-rays (including CT scans, mammograms and MRI scans) to diagnose illness – you may have x-rays or scans from time to time during and after your treatment to check the effect of your radiotherapy treatment.

Some radiographers, known as information radiographers, specialise in giving information to patients and their relatives.

Physicist

Mould room technician

If you need to have a mould made of part of your body to keep it still during treatment, this will usually be done by technical staff in the mould room.

Nursing staff

Other members of the cancer support team

Social worker

Social workers can give advice about any non-medical problems that you may have. This includes practical and financial help: for example, some patients can claim travelling expenses and others may be eligible for a grant from a charity. Social workers can also give or organise counseling and emotional support for you and your family. If necessary they will refer you to local support services that can help you at home. You can ask to see a social worker if you think that this would be helpful.

Symptom control team (palliative care team)

Counsellors

Secretaries and clerical staff

The secretaries and clerical staff in the radiotherapy department help to keep the appointment system running smoothly.

Specialised external radiotherapy techniques

Some newer ways of giving radiotherapy are being assessed to see whether they give better results than standard radiotherapy. Research studies are being carried out to see whether the new techniques can control the cancer better while causing fewer side effects. Some of the techniques are described below.

Conformal radiotherapy

Many specialist hospitals now use a specialised technique known as conformal radiotherapy. Conformal radiotherapy uses the same radiotherapy machine as normal radiotherapy treatment. However, metal blocks are put in the path of the x-ray beam to shape it to match the cancer. This ensures that a higher radiation dose is given to the tumour. Healthy surrounding cells and nearby structures receive a lower dose of radiation, so the possibility of side effects is reduced.

More recently a device called a multi-leaf collimator has been developed and can be used instead of the metal blocks. The multi-leaf collimator consists of a number of metal sheets which are fixed to the radiotherapy machine. Each sheet can be adjusted so that the radiotherapy beams can be shaped to the treatment area without using metal blocks.

Precise positioning of the radiotherapy machine is very important for conformal radiotherapy treatment and a special scanning machine may be used to check the position of your internal organs at the beginning of each treatment.

Intensity-modulated radiotherapy (IMRT)

High-resolution intensity-modulated radiotherapy also uses a multi-leaf collimator. During this treatment the layers of the multi-leaf collimator are moved while the treatment is being given. This method is able to shape the treatment beams even more precisely and allows the dose of radiotherapy to be altered over the whole treatment area.

Research studies have shown that conformal radiotherapy and intensity-modulated radiotherapy may reduce the side effects of radiotherapy treatment. However, it is possible that by shaping the treatment area so precisely, microscopic cancer cells just outside the treatment area may not be destroyed. This means that the risk of the cancer coming back in the future could be higher with these specialised radiotherapy techniques. Research studies currently being carried out should show whether this is the case.

Stereotactic radiotherapy

Stereotactic radiotherapy is used to treat brain tumours.

This technique directs the radiotherapy from many different angles so that the dose going to the tumour is very high and the dose affecting surrounding healthy tissue is very low. Before treatment, several scans are analysed by computers to ensure that the radiotherapy is precisely targeted, and the patient's head is held still in a specially made frame while having the radiotherapy. Several doses are given.

This treatment is available only in some specialist hospitals and is not suitable for all patients with brain tumours. You can discuss with your clinical oncologist whether it may be appropriate in your case.

Stereotactic radio-surgery (gamma knife)

In fact, this type of radiotherapy, again for brain tumours, does not use a knife but very precisely targeted beams of gamma radiotherapy from hundreds of different angles. Only one session of radiotherapy, taking about four to five hours, is needed.

For this treatment you will have a specially made metal frame attached to your head. Then several scans and x-rays are carried out to find the precise area where the treatment is needed. During the radiotherapy, you lie with your head in a large helmet, which has hundreds of holes in it to allow the radiotherapy beams through.

This treatment is available only in specialist hospitals and is not suitable for all patients with brain tumours. You can discuss with your clinical oncologist whether it may be appropriate for you.

External beam radiotherapy

About your treatment

External radiotherapy is normally given as a series of short, daily treatments in the radiotherapy department, using equipment similar to a large x-ray machine.

The treatments are usually given from Monday to Friday, leaving patients to rest at the weekend. Each treatment is called a fraction. Giving the treatment in fractions ensures that less damage is done to normal cells than to cancer cells. The damage to normal cells is mainly temporary, but is the reason why radiotherapy has some side effects.

The number of treatments you have depends on several factors, including:

your general health
the type of cancer being treated and where it is in the body
whether or not you have had, or are going to have, surgery, chemotherapy or hormonal therapy as part of your treatment.

For these reasons, treatment is individually planned for each patient, and even people with the same type of cancer may have different types of radiotherapy treatment.

External radiotherapy does not make you radioactive, and it is perfectly safe for you to be with other people, including children, throughout your treatment.

A course of curative (radical) treatment may be given every weekday for two to seven weeks. Instead of having one treatment a day or having a rest at the weekend, some people will have different treatment plans. They may have more than one treatment a day, or treatment every day for two weeks. Giving radiotherapy in this way is known as continuous hyperfractionated radiotherapy (often called CHART).

Sometimes treatment may be given on only three days each week (for example, on Mondays, Wednesdays and Fridays).

Palliative treatment (for symptom control) may involve only one or two sessions of treatment, or up to five sessions.

The different types of radiotherapy machine work in slightly different ways. Some are better for treating cancers near the surface of the skin, while others work best on cancers deeper in the body.

The type of radiotherapy machine used will be carefully chosen by your specialist and physicist to give you the most appropriate treatment. Some machines are quicker than others and may give treatment in a very short time, such as a few seconds. Usually, radiotherapy treatment (including the time taken to position you) takes 10-15 minutes or less, on any type of machine.

The radiotherapy machine does not normally touch you and the treatment itself is painless, although it may gradually cause some uncomfortable side effects. If you have a specific type of radiotherapy known as electron treatment, a small applicator may be used, which touches a small area of skin.

Radiotherapy affects people in different ways; some find that they can carry on working, taking time off for their treatment, while other people find it too tiring and prefer to stay at home. If you have a family to look after, you may find that you need extra help.

Don't be afraid to ask for help, whether it's from your employer, family or friends, social services, or the staff in the radiotherapy department. As your treatment progresses, you will have a better idea of how it makes you feel, so you can make any necessary changes to your daily life.

The radiotherapy staff will try to give you an appointment for the same time each day. This gives your body a chance to recover from any side effects between treatments and also allows you to get into a daily routine.

Getting to your appointment

If you have to do a lot of travelling each day to get to your appointment you may feel very tired, particularly if you are feeling some side effects from your treatment.

If the treatment makes you feel tired, you could ask a family member or friend to drive you to the hospital, or ask for hospital transport if friends or family cannot easily drive you there.

If you rely on your own or public transport you can usually arrange an appointment which suits both you and the radiographers. Some hospitals provide transport, and if necessary, this can be arranged for you by the radiotherapy staff.

Some local support groups and charities also provide hospital transport. If transport is very difficult, or you live a long way from the hospital, you may need to be admitted to the ward, or a hostel ward in the hospital or nearby. Sometimes it is possible for the hospital to organise local accommodation while you are having radiotherapy.

If you have difficulty meeting the cost of travelling to the radiotherapy clinic each day, you may be able to get a grant towards your travel expenses. People on a low income may be able to claim the costs from the Department of Work and Pensions. Some charities (such as Macmillan Cancer Relief) provide travel grants, and so do some local support groups. You can ask the hospital social worker or one of the nurses in the clinic for information on grants and advice on how to claim.

Giving your consent

Before you have your radiotherapy, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

the type and extent of the treatment you are advised to have
the advantages and disadvantages of the treatment
any possible other treatments that may be available
any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Planning your treatment

For some conditions, like many skin cancers and for palliative radiotherapy, radiotherapy may be planned and given in a very simple way.

For most curative (radical) treatments, planning is a very important part of radiotherapy and may take a few visits. Careful planning makes sure that the radiotherapy is as effective as possible. It ensures the radiotherapy rays are aimed precisely at the cancer and cause the least possible damage to the surrounding healthy tissues. The treatment is planned by a cancer specialist (clinical oncologist) and a physicist. You may have your first treatment on the same day as your planning session, but often it is necessary to wait a few days while the physicist and specialist prepare the final details of your treatment.

On your first visit to the radiotherapy department, you will be asked to lie under a machine called a simulator, which takes x-rays, or scans, of the area to be treated. The simulator moves in exactly the same way as the treatment machines, but rather than giving treatment it takes x-rays to help the radiographer plan the correct position for your treatment. This procedure takes about 15–45 minutes and may be quite tiring.

Instead of the simulator, sometimes an MRI (magnetic resonance imaging) scan is taken of the area to be treated. This may be done in the hospital scanning department before your planning session appointment. An MRI scan uses powerful magnetic fields to give a detailed picture of part of your body. The scanning department staff will explain the scanning process to you beforehand. Again, the scan is not painful, but you need to lie still for up to 10–30 minutes, which can be uncomfortable.

It is important for you to feel that you are involved in your treatment, so feel free to ask as many questions as you like.

Possible pregancy

Women of childbearing age will be asked whether they could be pregnant, as x-rays given during pregnancy could harm a baby. If you think that you may be pregnant, let the doctors and radiographer know immediately and you will be offered a pregnancy test.

Positioning

During the treatment planning you will be lying on a fairly hard couch that can be uncomfortable. If it is, let the radiographer know: you can be made more comfortable by having foam pads put underneath you. You have to lie very still for a few minutes so that accurate measurements can be taken and your exact position recorded. The radiographer can then make sure that you are lying in the correct position each time you have treatment.

Special procedures

Some special procedures may be necessary to make sure the radiographers get a clear picture. The radiographer will explain these to you. For example, to plan treatment to the pelvic area, a liquid that shows up on x-ray may be passed into your back passage or into your bladder, or a vaginal tampon may be used to show the exact position of the vagina. These procedures may be slightly uncomfortable but are not painful and take only a few minutes. They are used only for planning the treatment, and not during the treatment sessions.

Skin markings

Once the treatment area has been finalised, ink markings are usually made on your skin to pinpoint the exact place where the radiation is to be directed. The staff will explain how to look after these markings. If the marks begin to rub off, tell your radiographer. Do not try to redraw them yourself. Since they can rub off onto clothing, some people choose to wear older clothes next to the skin during their treatment.

Sometimes two, three or more permanent, pinpoint, tattoo marks are also made on the skin. This will only be done with your permission. It is a little uncomfortable while it is being done, but is a good way of making sure that your treatment machines are set up in the right way each time. The tattoo marks are also useful once treatment has finished, as they show where the radiotherapy was given and prevent further radiotherapy being given to that area in the future.

Mould room

As radiotherapy is planned very precisely, to treat exactly the right area, it is important to keep that part of the body as still as possible during treatment. For radiotherapy to some parts of the body, a see-through perspex device called a 'mould' or 'shell' may be made, to prevent movement during treatment. This is often used for treatments to the head and neck area. Any necessary marks can be made on the mould instead of on your skin. Your mould will be made before your treatment is planned.

In the mould room a plaster cast mould is made of the body part. Some people may find this claustrophobic or a little frightening, particularly if the mould is of the face and neck, but it takes only a short time.

After you leave the department, perspex is moulded on to the cast to form a mask. This mask fits snugly to your face and neck, with holes cut for your eyes, nose and mouth. The mould is ready to wear at your first planning or treatment session. Again, this may feel claustrophobic for some people, but try to remember that you will only have it on for a few minutes at a time.

Sometimes a mould of your leg or arm is used to keep the area still during your treatment.

A radiotherapy mask

Having your treatment

Before your first treatment, your radiographers will explain to you what you will see and hear. It is quite normal to feel anxious about having your treatment, but as you get to know the staff and understand what is going on it should become easier.

The sight of large radiotherapy machines can be frightening, especially for children. Don't be afraid to talk about any fears or worries to the staff; they are there to help you, and the more you understand about your treatment the more relaxed you will be.

Radiotherapy itself is painless and each session may take anything from a few seconds to several minutes. Because your positioning is so important, the radiographers may take a little while to get you ready (they may call this setting up). The room may be in semi-darkness while this is happening.

Try to relax as much as possible.

Once you are in the correct position the staff will need to leave you alone in the room, to prevent them from being exposed to any unnecessary radiation. Don't worry if the staff seem to rush out of the room once they have positioned you, this is just to keep your treatment time as short as possible. Radiotherapy units have many patients to treat and the staff need to keep appointments on time.

Some treatment rooms have tape players so that you can listen to music while having your treatment, to help you to relax. During treatment you will be alone for a few minutes but there will be an intercom so that you can talk to the radiographers. They will be watching you carefully from the next room, either through a window or on a closed-circuit television screen. To protect your privacy, no one else will be able to see you. If you have any problems you can raise your hand to attract the radiographers attention and they will come in to help you.

Most radiotherapy machines will be able to rotate around your body to give the treatment from several different directions. At first, this and the sound of the machine, can be unsettling.

Positioning the radiotherapy machine

The radiographers may have to come into the treatment room and change your position slightly in the middle of your treatment. Also, small changes sometimes have to be made to your treatment plan. There may be a number of reasons for this and your specialist will explain these changes to you and keep you up to date with your progress.

Making a radiotherapy mask

This information is about the process of making a radiotherapy mask. Perspex and plastic masks are sometimes used when radiotherapy is given to the brain, or the head and neck area. It may be helpful to read this with our information on brain tumours or head and neck cancer, as well as our information on radiotherapy. You may also want to discuss it with a nurse or doctor involved in your treatment.

Radiotherapy masks

Radiotherapy is the use of x-rays (and other rays) to treat cancer. Radiotherapy has to be aimed very precisely to make sure that exactly the right area of the body is treated each time.

It is important that a person having radiotherapy lies still for a few minutes while the treatment is in progress. However, when radiotherapy is given to treat tumours of the head and neck area or brain tumours, it is even more important to be as still as possible. This is because even a tiny movement could influence the effectiveness of the radiotherapy.

To help with this, a radiotherapy mask (which is sometimes called a mould, a head shell or a cast) is made to be worn during the treatment. The mask is fixed to the radiotherapy treatment table and this ensures that your head and neck are held in exactly the right position for the treatment. Wearing a mask reduces the possibility of any movement whilst the radiotherapy is given. The mask is only worn during the treatment planning procedures and during the treatment itself, ie, for only a few minutes at a time each day. You will not have to wear the mask at any other time.

How the mask is made

The mask is made in the mould room of the radiotherapy department by a mould technician or radiographer. The process of making the mask can vary slightly between hospitals and usually takes around 30 minutes. One technique uses wet plaster bandages and the finished mask is made of perspex. The other technique uses a type of mesh plastic, which is moulded to fit the shape of your face.

Perspex mask

If you are having a perspex mask you may be given a swimming cap or some other covering to wear, to protect your hair from the mould mixture.

Firstly, the mould technician will apply a cool cream or gel onto your face. Then, they will put strips of plaster of paris bandage on top of this. You will still be able to breathe, as holes are left around your nose and mouth.

Plaster of paris is applied to the face to make a mould

Plaster of paris gets warm while it is setting. This is normal and may make the process uncomfortable. Do not worry: it will not burn you. Once the plaster of paris has set (which will take about 5 minutes) the mould is taken off. A perspex mask is then made from this mould.

Mesh plastic mask

This technique uses a special kind of plastic. The plastic is heated in warm water so that it becomes soft and pliable. It is put onto your face so that the plastic gently moulds to fit your face exactly. It feels a little like having a warm flannel put onto your face. You can still breathe easily, as the plastic will not cover your nose or mouth.

Once the mesh has moulded and become hard (which takes a few minutes) the mask is taken off. It is then ready to be used when you have your treatment.

A warm plastic mesh is put onto your face so that the plastic gently moulds to fit your face

Treatment planning

Once the mask is ready, you might need to visit the mould room again so that adjustments can be made to position the mask correctly on the radiotherapy treatment table. You may also have your treatment planned during this visit. Treatment planning ensures that the radiotherapy is aimed very precisely at the cancer. You may be positioned on a machine called a simulator (which helps the radiographer to work out the exact position you need to be in). Sometimes scans or x-rays are necessary to help with planning. The doctor or radiographer may make a few ink marks on the mask; this makes it easier to position you correctly each time you come in for treatment. Radiotherapy planning can take more than one visit.

When you have the radiotherapy you will be lying down on a table below the radiotherapy machine. The mask is placed on your face and fixed to the table so that your head doesn’t move while the radiotherapy is being given. Treatment usually takes only a few minutes and is not painful. The staff will be close by to answer any questions that you may have.

People often worry about how it will feel to wear a mask during treatment, but they usually find that it’s not too uncomfortable. Most people get used to wearing the mask and after a while, they don’t notice it.

Internal radiotherapy

What is internal radiotherapy?

Internal radiotherapy is used mainly to treat cancers in the head and neck area, the cervix, the womb, the prostate gland or the skin.

Treatment is given in one of two ways:

by putting solid radioactive material (the source) close to or inside the tumour for a limited period of time
by using a radioactive liquid, which is given either as a drink or as an injection into a vein.

If you have internal radiotherapy, you may have to stay in hospital for a few days and special precautions will be taken while the radioactive material is in place in your body. Once the treatment is over there is no risk of exposing your family or friends to radiation.

The process of putting solid radioactive material close to or inside the tumour is called brachytherapy.

Giving a radioactive liquid, either as a drink, a capsule, or as an injection into a vein is called radioisotope treatment. Your specialist will discuss your particular treatment with you.

Before having your treatment you will be asked to sign a form to say that you give your permission (consent).

Safety measures for internal radiotherapy

To prevent unnecessary radiation exposure to the hospital staff and your friends and relatives, certain safety measures will be taken while you are being treated with the radioactive source, or a liquid radioisotope. Depending on the type of treatment you are having, the restrictions may be needed for a few days – but sometimes it is only for a few minutes.

The staff looking after you will explain the restrictions to you in more detail before you start your treatment. Each hospital has different routines, and it is worth visiting the treatment area beforehand to discuss with the nursing and medical staff what will happen.

You may be admitted to the ward the day before your treatment so that the staff can go over the procedure with you. This is a good time to ask questions and it may help to make a list beforehand so you don't forget something important.

While the radioactive source is in place, or after treatment with a liquid radioisotope:

You will be nursed in a side room, away from the main ward.
You may be nursed alone or with someone else having similar treatment.
Lead screens may be put on either side of your bed to block any radiation given out and protect other people.
The doctors and staff on the ward will stay in your room only for short periods at a time.
Children and pregnant women will not be allowed to visit.
An intsrument called a geiger counter may be used to monitor the level of radiation in the room. The nurses may wear a small radiation counter.
Visitors will be restricted, and allowed to stay in the room or sit at the end of the bed only for a short time, if at all. They may be able to talk to you from outside the room through an intercom.
Staff and visitors will be asked to keep away from you, to reduce their exposure to the radiation.

The safety measures and visiting restrictions might make you feel very isolated, frightened and depressed at a time when you might want people around you. If you have these feelings it is important that you let the staff looking after you know. It might also be helpful to take in plenty of reading material and other items to keep you occupied while you are in the single room.

Brachytherapy

If you are having brachytherapy, you only need to stay in isolation while the radioactive source is in place. Once it is removed the radioactivity disappears and it is perfectly safe to be with other people.

Radioisotope

If you are having treatment with a radioisotope (liquid), the radioactivity will disappear gradually and you will need to stay in isolation only until the radiation in your body has broken down. Before you leave hospital, the staff will check that most of the radioactivity in your body has gone, and that your belongings are free from any signs of radioactivity. After you leave hospital you should be able to carry on your life almost as normal, but there may be a few restrictions about contact with people – especially children and pregnant women – for a few more days.

Your feelings

People are different in the way they handle their fears; some want to know everything about their treatment, while others prefer to know as little as possible. If you need any explanations the staff on the ward will be happy to help you. It often helps to bring any fears or worries you have into the open by talking to the staff or to family and friends. You will probably be in the single room only for a short time, perhaps only one or two days, during which you can read your books and magazines, watch TV or listen to the radio.

Brachytherapy

Intracavitary radiotherapy

This type of internal radiotherapy treatment is used for treating cancer of the cervix, womb (uterus) or vagina. A piece of radioactive metal, known as a source, is put close to the area of the cancer. The metal most commonly used is caesium-137. The advantage of treatment with caesium is that it gives a high dose of radiotherapy directly to the tumour, but a low dose to normal tissues.

The caesium is put inside a hollow, plastic tube known as an applicator. Sometimes more than one tube is used. This keeps the caesium in place. The applicator is inserted into the vagina while you are under a general anaesthetic or sedation in the operating room. At the same time, a flexible tube called a urinary catheter may be put into your bladder to drain off urine. This means you will not have to get on and off bedpans, which could dislodge the applicators.

Once the applicator is in place, an x-ray will be taken to check it is in the correct position. Sometimes the radioactive source is put into the applicator while you are in the operating room, but more commonly it will be put in place once you are back on the ward. The applicator is kept in place by a pack (cotton/gauze padding) inside your vagina. This can be uncomfortable and you may need to ask your nurses for regular painkillers.

Once the source is put into the applicators you have to stay in bed, so that the applicator does not move out of position. If you need anything, you can call a member of staff by using the bell by your bed. If the source does move out of position, you need to call the staff on the ward immediately.

Selectron machine

In many hospitals a machine called a Selectron, or similar name, is used to put the radioactive material into the applicators. The machine is attached by tubes to the applicators. When the machine is switched on it passes small radioactive balls into the applicators. If the machine is switched off, the radioactive balls are pulled back inside the machine. The machine is kept switched on throughout treatment, except when someone needs to go into your room. It can then be turned off, to reduce their exposure to the rays. However, safety measures and visiting restrictions are still necessary. The time you spend on the machine varies but it is usually between 12–48 hours.

Microselectron

Sometimes a machine called a Microselectron is used for internal radiotherapy. It gives the radiotherapy more quickly, so the treatments last for only a few minutes and you can go home the same day.

After the treatment

Once the complete radiation dose has been given, the source and the applicators will be removed. This is usually done on the ward. As it can be a little uncomfortable, you will be offered some painkillers beforehand. Sometimes a few breaths of the gas Entonox will help you to relax. Staff on the ward will check that all the applicators and sources have been removed. Your catheter may be removed at the same time.

Your specialist may suggest that you use vaginal douches for a few days after the applicator has been removed to keep the vagina clean. Your nurse will tell you how to use these.

You will probably be able to go home the same day, or the following day. Once the radioactive sources are removed, all traces of radioactivity immediately disappear.

Many women are given both internal and external radiotherapy to ensure the cancer is treated in the most effective way.

Side effects

It is not unusual to have slight bleeding or discharge once the radiotherapy treatment has ended. If it continues or becomes heavy it is important to let your doctor or nurse know.

Radiotherapy to the pelvic area can cause side effects such as tiredness, diarrhoea and a burning sensation when passing urine. These side effects can be mild or more troublesome depending on the strength of the radiotherapy dose and the length of your treatment. Your oncologist will be able to advise you what to expect.

Most of these side effects can be treated with medicines, which your oncologist will provide. Any side effects should gradually disappear once your treatment is over.

It is important that you drink plenty of fluids and maintain a healthy diet during your treatment. If your diarrhoea is not controlled with medicines you can ask to see a dietitian, who can advise you on what to eat to reduce diarrhoea. You may feel sick but this is not common. If you don't feel like eating, you can replace meals with nutritious high-calorie drinks, which are available from most chemists and can be prescribed by your GP. The section on diet and cancer has some helpful tips on eating well when you are feeling ill.

Radiotherapy for cancer of the cervix affects the ovaries, unfortunately, and this brings on the menopause, usually about three months after the treatment starts. This means that your periods will stop and you will have menopausal side effects such as hot flushes, a dry skin and possibly loss of concentration. Some women become less interested in sex and notice that their vagina is dry. Sometimes radiotherapy causes a narrowing of the vagina, which can make sexual intercourse uncomfortable. See our sections on sexuality and fertility.

You can be protected from menopausal side effects by taking HRT (hormone replacement therapy) as tablets or skin patches. These can be started by your gynaecologist during the radiotherapy treatment or shortly after it has ended. They will help choose the correct replacement hormones and dosage.

It is important to get as much rest as you can, especially if you have to travel a long way for treatment each day.

Possible long term side effects

Radiotherapy to the pelvic area can sometimes cause long-term side effects. However, improvements in treatment planning have made these much less likely.

In a small number of people, the bowel or bladder may be permanently affected by the radiotherapy. If this happens the increased bowel motions and diarrhoea may continue, or the person may need to pass urine more often than before. The blood vessels in the bowel and bladder can become more fragile after radiotherapy treatment and this can make blood appear in the urine or bowel movements. This can take many months or even years to occur.

If you notice any bleeding it is important to let your doctor know so that tests can be done and appropriate treatment given.

Our section on pelvic radiotherapy in women has tips on coping with these side effects.

Some people also find that radiotherapy affects the lymph glands in the pelvic area and can cause swelling of the legs. This is known as lymphoedema. It is more likely if you have had surgery as well as radiotherapy.

After caesium brachytherapy there is a slight risk of infection, but this is very rare. If you develop a high temperature or heavy bleeding after your treatment, contact your specialist as soon as possible. You will be prescribed antibiotics to treat the infection.

Caesium or irridium wires

These can be used to treat a number of types of tumours including those in the mouth, lip, cervix and breast. Very thin radioactive needles, wires or tubes are inserted while you are under general anaesthetic in the operating room.

An x-ray may be taken to ensure that the needles are in the correct position. You will be nursed in a separate room, and safety measures will be used until the wires are removed – usually after three to eight days. Sometimes this is done under general anaesthetic.

Wires in the mouth can be uncomfortable, and can make eating and talking difficult. You will need to have a soft or liquid diet while they are in place. Your nurse will show you how to keep your mouth clean, using regular mouthwashes. If eating is a problem you may be fed through a thin tube (a nasogastric tube), passed up your nose and down into your stomach.

The wires are removed once the correct dose of radiation has been given. This may be after two days if the treatment is given as a booster after external treatment, or up to one week if it is the only type of radiotherapy treatment being given.

Once the wires have been removed, the area will feel sore for up to two or three weeks afterwards. Your specialist will prescribe painkillers that you can take regularly until this improves.

Brachytherapy for prostate cancer

Brachytherapy (radioactive seed implants) is sometimes used to treat small tumours of the prostate gland. Brachytherapy is available in some hospitals in the UK. It is carried out under a general anaesthetic, or sometimes a spinal anaesthetic. Small radioactive metal seeds are inserted into the tumour within the prostate gland, and they release small doses of radiation very slowly over a period of time. The seeds are not removed, but stay in the prostate tissue. The radioactivity gradually fades away over approximately a year. The radiation affects only the area a few millimetres around the seeds, so there is no danger of it affecting other people. See the section on prostate cancer that explains this treatment in more detail.

Radioisotopes

These are given as liquids, in capsules that are swallowed or as a drink; or by injection into a vein (as an intravenous injection). The most common type of radioisotope treatment is radioactive iodine. Used to treat tumours of the thyroid gland, it is given as an odourless and colourless drink. The same safety precautions are taken with this type of treatment as for brachytherapy.

Any radioactive iodine that is not absorbed by the thyroid will be passed from the body in sweat and urine. You need to drink plenty of fluids during your treatment as this helps to flush the iodine out of the body. The amount of radiation in your body will be checked regularly and as soon as it falls to a safe level, after about four to seven days, you will be able to go home. You may need to take some special precautions for a short time after going home – and may need to avoid young children and pregnant women for a short time. The hospital staff will explain this to you.

Radioactive iodine does not usually cause side effects, but you may feel very tired for a few weeks after having this treatment.

Radioisotope treatment can also be given if certain types of cancer have spread to the bones (secondary bone cancer). A radioisotope is injected into a vein, and can be given as an out-patient. Before you go home you will be given some simple advice to follow, as your urine and blood will be slightly radioactive for a few days. This type of radiotherapy treatment does not usually cause any side effects, apart from tiredness for a few weeks.

You can read more about radioisotope treatment in the sections on thyroid cancer and secondary bone cancer.

After your radiotherapy treatment has finished

After your radiotherapy treatment has finished you will have regular follow-up appointments. These may be at the radiotherapy department or at your original hospital. The positive effects of radiotherapy may take some time to show. People sometimes expect to be given an x-ray or a scan at the end of their treatment to see if it has worked. However, in many cases the tumour may take some time to shrink, which means that x-rays and scans may not be helpful at this time.

How often you have check-ups will vary depending on your type of cancer, and from one hospital to another; but as time goes by they will become less frequent. Your specialist will keep in contact with your own family doctor so they will know about your progress. Follow-up appointments are a good opportunity to discuss any problems or worries that may have arisen. It may help to make a list beforehand so that you don't forget anything important.

For people whose treatment is over apart from regular check-ups, our section on adjusting to life after cancer gives useful advice on how to keep healthy and adjust to life after cancer.

If you have any problems, or notice any new symptoms in between these times, let your doctor know as soon as possible. You don't have to wait until your next scheduled appointment – just ask for an earlier appointment.

Many people find that they get very anxious for a while before the appointments. This is natural and it may help to get support from family, friends or one of the counselling organisations listed.

Emotional effects

Sometimes the hardest time to cope with is when treatment is finished and you, and everyone else, see this as the time to get back to normal. Recovery time varies, and no one can say for sure how long you should take to get over the side effects, the tiredness and the emotional effects. The end of the visits to hospital for treatment can leave you feeling alone and neglected. Many people find that they feel very low and emotional at this time, when they had expected to be able to put the cancer and the treatment behind them. This may be the time when you need most support. See our list of counselling organisations.

Long-term side effects

All treatments used against cancer (including surgery, chemotherapy and radiotherapy) can result in long-term side effects. Modern treatments are designed to limit the chance of permanent side effects as much as possible. If you are concerned about the risk of developing particular side effects from radiotherapy, it is best to speak to your specialist.

General information on radiotherapy

2007-07-09T11:22:00.000-07:00

This section has been written to give you information about radiotherapy. We hope that it will answer some of the questions that you may have about this treatment.

If you have any further questions relating to your treatment, please don't hesitate to ask the doctor, nurse or radiographer looking after you. It is important to talk to someone who is familiar with your treatment, as radiotherapy differs from one person to another. Other people you meet may be having different treatments, even if they have a similar type of cancer.

What is radiotherapy?

Radiotherapy is the use of x-rays and similar rays (such as electrons) to treat disease.

Since the discovery of x-rays over one hundred years ago, radiation has been used more and more in medicine, both to help with diagnosis (by taking pictures with x-rays), and as a treatment (radiotherapy). While radiation obviously has to be used very carefully, doctors and radiographers have a lot of experience in its use in medicine.

Many people with cancer will have radiotherapy as part of their treatment. This can be given either as external radiotherapy from outside the body using x-rays or from within the body as internal radiotherapy.

Radiotherapy works by destroying the cancer cells in the treated area. Although normal cells are also sometimes damaged by the radiotherapy, they can repair themselves.

Radiotherapy treatment can cure some cancers and can reduce the chance of a cancer coming back after surgery. It may be used to reduce cancer symptoms.

Some people find that the side effects are very mild and that they just feel tired during their course of radiotherapy treatment.

Why radiotherapy is given

Curative treatment

Radiotherapy is often given with the aim of destroying a tumour and curing the cancer. When radiotherapy is given in this way it is described as radical radiotherapy.

Radiotherapy may be used on its own or may be given before or after surgery or chemotherapy. Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. If radiotherapy and chemotherapy are given at the same time, this treatment is known as chemoradiotherapy.

For some types of curative radiotherapy treatment, you may need to go to the hospital each weekday for between two and seven weeks. In this situation, a small dose of radiotherapy is given each time. This is because as well as damaging cancer cells, radiotherapy can also cause damage to healthy cells in the treatment area. If a very high dose of treatment was given all in one go, it could cause too much damage to the healthy cells, so small doses are given to allow the healthy cells to recover in between.

Palliative treatment

Sometimes, when it is not possible to cure a cancer, radiotherapy may be given to relieve symptoms - for example, to lessen pain. This is called palliative treatment. Lower doses of external radiotherapy are given than for curative treatment, usually over a shorter period of time (sometimes just a single treatment).

Total body irradiation

This type of radiotherapy is used much less commonly than the other types of radiotherapy, but is often given to patients who are having a bone marrow or stem cell transplant as part of their treatment. A large single dose, or six to eight smaller doses, of radiation is given to the whole body to destroy the cells of the bone marrow. Very high doses of chemotherapy are also given. This treatment is followed by giving new bone marrow given by a drip into a vein, to replace the bone marrow that has been destroyed. This type of radiotherapy is described in the section on stem cell and bone marrow transplants.

Research - clinical trials for radiotherapy treatments

Cancer research trials are carried out to try to find new and better treatments for cancer. Trials that are carried out on patients are known as clinical trials. When you are given radiotherapy it may be as part of a clinical trial and this will be explained to you.

Clinical trials may be carried out to:

test new treatments, such as new ways of giving radiotherapy, new chemotherapy drugs, gene therapy or cancer vaccines
look at new combinations of existing treatments, or change the way they are given, in order to make them more effective or to reduce side effects
compare the effectiveness of drugs used for symptom control
find out how cancer treatments work
see which treatments are the most cost-effective.
Trials are the only reliable way to find out if a different operation, type of chemotherapy, radiotherapy, or other treatment is better than what is already available.

Taking part in a trial

You may be asked to take part in a treatment research trial. There can be many benefits in doing this. Trials help to improve knowledge about cancer and the development of new treatments. You will also be carefully monitored during and after the study. Usually, several hospitals around the country take part in these trials.

The process of clinical trials is described in more detail in a separate section on cancer research trials.

Blood and tumour samples

Many blood samples and bone marrow or tumour biopsies may be taken to find out what is wrong with you. Most of these are needed to make the right diagnosis. You may be asked for your permission to use some of your samples for research into cancer. Some samples may be frozen and stored for future use, when new research techniques become available.

The research may be carried out at the hospital where you are treated, or it may be at another hospital. This type of research takes a long time, so you are unlikely to hear the results. The samples will, however, be used to increase knowledge about the causes of cancer and its treatment. This research will, hopefully, improve the outlook for future patients.

Children and radiotherapy

Radiotherapy can be a frightening experience for both children and their parents, but once everyone understands what is involved this fear can be reduced. The radiotherapy staff are used to treating children and they can offer help and support.

Young children, especially if they are aged three or younger, may have their treatment under a mild general anaesthetic. As your child can't eat or drink for at least four hours before his or her treatment, you will probably have a morning appointment. The anaesthetic is usually given in the radiotherapy department by an anaesthetist. You can stay with your child until they are asleep.

Although you won't be able to stay in the radiotherapy room during your child's treatment, you can watch through the window or on the TV screen. The nurses will look after the child until they wake up, usually after 20 minutes to an hour. You will then both be able to go home, unless your child is an in-patient, in which case a nurse will take them back to the ward.

Older children may take a while to get used to the size and sound of the machines, but this should get easier once they get to know the staff and the surroundings. If you are finding it difficult to cope with your child's illness, you may find it helpful to contact one of the children's cancer groups. Sharing your experiences with other parents can help you to cope with your own problems and fears. Contact Cancerbackup's Cancer Support Service for details of these groups.

Cancerbackup has information on children's cancers which includes more about radiotherapy treatment for children.

Work and radiotherapy

Sometimes people can carry on working part-time during their treatment, but many people feel very tired and may feel unwell. In this case you may need to make changes to your usual routines. Most employers will be sympathetic if you explain why you need time off work. It is helpful to talk to your employer or personnel officer to explain how much time off you may need and what you will be able to do. It can be hard to predict exactly what you will be able to do, but your employer will appreciate being given some idea of what to expect.

For further information, see our sections on work and cancer, which includes details of benefits and financial help.

Photodynamic therapy (PDT)

2007-06-30T03:43:00.000-07:00

This information is about photodynamic therapy (PDT). PDT is a treatment for some types of cancer. It may also be used to treat some non-cancerous conditions of the skin or eye.

How PDT works
When PDT is used
How PDT is given
PDT and possible side effects
PDT for skin cancer
PDT for cancers of the head and neck
PDT for other cancers

How PDT works

PDT uses laser, or other light sources, combined with a light-sensitive drug (sometimes called a photosensitising agent) to destroy cancer cells.

A photosensitising agent is a drug that makes cells more sensitive to light. Once in the body, the drug is attracted to cancer cells. It does not do anything until it is exposed to a particular type of light. When the light is directed at the area of the cancer, the drug is activated and the cancer cells are destroyed. Some healthy, normal cells in the body will also be affected by PDT, although these cells will usually heal after the treatment.

When PDT is used

PDT may be used to treat cancers of the skin (but not melanoma), or those that are on, or near, the lining of internal organs, such as cancers of:

the head and neck area
the lining of the mouth
the lining of the lung
the lining of the gullet (oesophagus)
the lining of the stomach
the lining of the bladder
the lining of the bile ducts.

Doctors are working to identify the types of cancer for which it is most effective. Research trials are taking place to look at new photosensitising agents, new laser and non-laser light treatments and ways of reducing the side effects.

Your doctor can advise you whether PDT is an appropriate treatment in your situation, and whether you may be able to take part in any research trials.

In cancers that are being treated at an early stage, the aim of treatment may be to try to cure the cancer.

The aim of PDT for advanced cancer is usually to reduce symptoms by shrinking the tumour. In this situation PDT cannot cure a cancer.

Photodynamic therapy treatments for some cancers, such as prostate and pancreas, are still the subjects of research. Some research studies have used PDT to treat conditions that may develop into a cancer, including one which affects the vulva known as vulval intraepithelial neoplasia (VIN).

PDT can safely be given to patients who have had other cancer treatments such as surgery, radiotherapy and chemotherapy.

How PDT is given

The treatment is normally in two stages.

Stage 1 A light-sensitive drug is given. For cancers of the skin, the drug is usually applied to the skin as a cream.

For cancers that are inside the body, the drug is usually given by injection into a vein.

There is a delay between the cream being applied, or the drug being given, and the next stage of treatment. This allows time for the drug to concentrate in the cancer cells.

Stage 2 The second stage of treatment involves shining light directly on to the cancer. A laser delivers energy in the form of light in a very precise way. Special non-laser lamps may also be used in some situations. For skin cancers, the light is shone directly onto the skin. For internal cancers, a flexible tube (an endoscope) may need to be passed into your body to deliver the light to the tumour.

PDT and possible side effects

As with all kinds of treatment, the experience of PDT can vary from person to person. How the treatment is given and the side effects that it may cause vary, according to:

the area of the body affected by the cancer
the type of photosensitising drug given
the time between giving the drug and applying the light
the amount of skin sensitivity to light following treatment.

When PDT is used to treat skin cancer, the side effects are different to when PDT is used for a cancer elsewhere in the body. For this reason we have divided this information into two: firstly for people being treated for skin cancers, and secondly for people with cancer in any other part of the body.

PDT for skin cancer

A photosensitising cream will be applied to the affected area of skin. You will then need to wait for approximately 4–6 hours before being treated. Treatment with the PDT light will last 20–45 minutes, after which a dressing will be put on to cover the area and protect it from light. Usually only one treatment is needed, but occasionally two or three further treatments may be given.

Possible side effects of PDT for skin cancer

Pain You will be given a local anaesthetic before your PDT, to prevent pain. For many people this is all that they will need. You may be given steroid cream to apply to the area if it hurts when you are at home.

Sensitivity to light The treated area of skin will be sensitive to daylight and bright, indoor lighting. This effect will probably last for between 24–36 hours. You will need to keep the treated area of skin covered during this time. After that you can wash, bathe or shower as usual, but you will still need to treat your skin gently and not rub the area until it has healed.

Healing – a scab will form on the treated area The scab usually falls off after about three weeks. As PDT heals quickly without scarring, the appearance after treatment is usually very good.

PDT for cancers of the head and neck

The photosensitising drug is given as an injection through a small tube (cannula) inserted into a vein. This takes a few minutes and then the tube is removed.

You will then have to wait up to about four days before the light treatment is given. The length of time varies depending upon the particular photosensitising drug you've been given. Generally, only one treatment is given, although it is possible to have a second treatment a few weeks after the first.

Possible side effects of PDT for head and neck cancers

Sensitivity to light Although photosensitising drugs are mostly taken up by the cancer cells and are concentrated there, they can also make your ordinary skin cells, or your eyes, highly sensitive to light. People who have had PDT are advised to protect themselves from exposure to sunlight and bright indoor lighting. The duration of sensitivity to light (photosensitivity) varies depending upon which drug is used. The drug temoporfin (Foscan®) is commonly used to treat head and neck cancers and will make you sensitive to direct sunlight for up to two weeks.

While your skin is photosensitive, it is advisable to avoid going outside during the day. However, you do not need to stay in total darkness during this time. To start with you will need to stay in a darkened room, but you can gradually build-up the amount of light over two weeks. If you need to go out, use clothing to cover your skin: for example, wear a brimmed hat, scarf, long-sleeved shirt or blouse and trousers, gloves and dark glasses. Using sunscreens will not give you any additional protection.

You can go out uncovered very early in the morning or after sunset, and you can use low-level artificial light indoors (maximum 60W bulb). In the first few days it is possible to get ‘sunburn’ even on a dull winter day. You will not notice that you are getting burnt while you are out in the sun. As with sunburn, the damage to your skin can take a few hours to show up.

You can even get burnt through glass if the light is strong. Remember to draw curtains during the day if the sun is bright. Bright artificial lights can also cause a skin reaction, so spot lamps are best avoided. It is important to be aware of unexpected sources of light – for instance, warming your hands over a fire could result in being burnt. It is also a good idea not to use a computer during this time and not to watch the television from less than about 2 metres (6 feet) away. You may be given a light meter to use at home, to check that the light intensity is at a safe level.

It is advisable to avoid opticians’ appointments around the time of your treatment, as the retinas inside your eyes will be more vulnerable to light than usual, and you should not have light shone into your eyes.

Towards the end of the time of photosensitivity, a small area of skin can be exposed to brighter light for five minutes and the reaction assessed 24 hours later. Your doctors will advise you on how to do this. After this time, you will be able to gradually increase the amount of light you are exposed to and most people are able to go outside as usual after approximately three weeks. Your doctor or specialist nurse can let you know for exactly how long you will need to protect your skin.

Pain Treatment with PDT can cause pain in the tumour area. Your specialist nurse should be able to tell you how much pain you might expect and see that you are given appropriate painkillers. The amount of pain will vary according to where your tumour is and which light-sensitising drug has been used. Pain can range from mild to severe. For some treatments aspirin or paracetamol may be enough, however for others a morphine-type drug may be necessary. If you have pain, it is important to let your doctor know, so that you can be given effective and appropriate painkillers.

Swelling Some photosensitising drugs can cause swelling in the treated area. This varies from one person to another. If you have had treatment in your mouth or throat, the swelling may make it difficult to swallow. It is important to let your nurse or doctor know if swallowing becomes very difficult. The swelling is only temporary but can be treated with steroid injections or drugs that help to reduce inflammation.

Constipation This is a fairly common side effect of PDT and you may need to ask your doctor for medication.

Nausea Some people may feel sick, which can be controlled with mild anti-sickness tablets if necessary.

Healing PDT causes much less scarring than surgery. However, the time taken for PDT-treated areas to heal can vary a lot. It may be several weeks, depending on the area treated and how deeply the light has penetrated into the body tissues.

PDT for other cancers

Other than skin cancer, and cancers of the head and neck, the cancers most commonly treated with PDT are those found in the inner lining of the digestive system, the lungs and the bladder. However, as PDT is a new treatment, it may start to be used for other cancers. If the cancer is on the lining of an internal organ such as the gullet (oesophagus), stomach or lungs, it may be necessary for a thin, flexible tube to be passed into the windpipe or gullet to bring the laser light as close to the cancer as possible.

If the cancer is inside the bladder, a tube will be passed into the bladder. You would be given a drug to make you sleepy (sedated) while this part of the treatment is given.

There are several drugs that can be used as the photosensitising agent. The most common are 5-aminolevulinic acid (ALA), temoporfin (Foscan®) and porfimer sodium (Photofrin®). The drug used will depend on the type of cancer that you have and which is best for your situation. These drugs may be given as a drink or tablets or as an injection. The way that the drug is given will depend on which one is best for your treatment.

The length of time you need to wait for treatment after having the drug can vary from 90 minutes to four days. You will be told which drug will be used, how it will be given and whether your treatment is to be as an outpatient or if you will need to stay in hospital.

Possible side effects of PDT for other cancers

PDT drugs for cancers in other parts of the body are usually given by injection into a vein. Many of the side effects will be similar to those experienced by people who have had PDT for head and neck cancers. The time of sensitivity to light (photosensitivity) varies, ranging from one or two days to several months. This difference depends on which photosensitising drug is used. Your doctor or specialist nurse can let you know the length of time you will need to protect your skin.

You may also have some pain, nausea and constipation. Other side effects will depend upon the part of the body that is treated.

Cancer and pre-cancer of the gullet (oesophagus) Swelling and inflammation can occur around the treatment area and may cause nausea and chest pain. This may make swallowing difficult.

Cancer of the stomach The lining of the stomach may become inflamed and swollen, causing abdominal discomfort and nausea.

Cancer of the lung The PDT may cause swelling and inflammation in the lung which may cause some chest pain, a cough and breathlessness. You may notice that you are producing more sputum and rarely you may cough up blood-stained sputum. Occasionally there may be a build-up of fluid in the lining of the lung (a pleural effusion), which can be drained if necessary.

Cancer of the bladder It is likely that the PDT will cause symptoms of an inflamed bladder. Common problems include pain, the need to pass urine frequently, slight leakage of urine (incontinence), and passing small amounts of blood in the urine. These side effects usually last for only 2–4 weeks after treatment.

Cancer of the prostate PDT as a treatment for prostate cancer is still at an experimental stage. Possible side effects include mild incontinence of urine and difficulty passing urine.

Cancer of the pancreas PDT as a treatment for pancreatic cancer is still being researched and is not widely available. Possible side effects include abdominal pain and diarrhoea.

Hyperthermia treatment

2007-06-30T03:33:00.000-07:00

This information is about the use of hyperthermia treatment in cancer. It is mainly used as part of research trials and is usually given with other cancer treatments such as radiotherapy (high-energy rays) and chemotherapy (anti-cancer drugs).

Hyperthermia is used to treat a number of different types of cancer. These include cancer of the gullet (oesophagus), stomach, breast, pancreas, cervix and rectum. It can also be used to treat melanoma, mesothelioma and some types of soft tissue sarcoma.

Hyperthermia treatment
How hyperthermia treatment works
How the treatment is given
Local hyperthermia treatment
How local hyperthermia treatment is given
Possible side effects
Skin care

Hyperthermia treatment

Hyperthermia means an abnormally high body temperature. It is thought that heating areas of the body that contain a cancer, or heating the tumour itself, may help to kill cancer cells. This treatment exposes the body tissue to high temperatures, between 40°–45°C (104º–113ºF), without harming surrounding healthy tissue. The normal body temperature is 37°C (98.6ºF).

Hyperthermia treatment is mostly used to treat cancer that is localised in one part of the body. Giving hyperthermia treatment in combination with chemotherapy drugs or radiotherapy, or with both, may help to improve the effect of these treatments.

At the moment hyperthermia treatment is not available in the UK. It is available in Europe however, and a small number of patients in the UK may be able to have this treatment abroad through the NHS. Hyperthermia is suitable for breast cancer that has come back in the breast area (local recurrence).

How hyperthermia treatment works

Hyperthermia treatment destroys cancer cells by raising the tumour temperature. This is similar to the way the body uses fever to fight infection.

When normal body tissue is heated the blood vessels open up (dilate) to allow the blood to flow more freely. This helps to cool down the area and prevent damage. The blood supply to cancer cells is different. The blood vessels cannot dilate as well and blood flow is generally slower. When heat is applied to a cancer, the cells are less able to cool down and are more likely to be damaged by the high temperature. The effect of the heat damages the cancer cells and can deprive them of the nutrients they need to survive.

Hyperthermia treatment is almost always used in combination with either radiotherapy or chemotherapy.

How the treatment is given

How the treatment is given, and how much treatment is needed, depends on a number of factors. These include the part of the body affected by cancer and the size and shape of the tumour.

There are three ways in which hyperthermia can be given, depending on how much of the body needs treatment. These are known as local, regional and whole body hyperthermia. This information discusses local hyperthermia. If you would like information about regional or whole body hyperthermia, please contact our cancer support service nurses.

Local hyperthermia treatment

In local hyperthermia treatment, heat is applied to a small area only. This is done using applicators that are placed close to, or in, the tumour. There are different ways to deliver local hyperthermia: external; intraluminal (also called endocavitary); and interstitial. The method used depends on the type and position of the tumour.

External This is the technique that is used to treat breast cancer. It is also used for cancers that are on, or just below, the skin. The tumour is heated externally using applicators that are placed on, or near to, the affected area. Heat is then applied using high-frequency energy waves generated from a device outside the body (such as a microwave or ultrasound).

Intraluminal or endocavitary hyperthermia This may be used to treat cancers that are within or near to body cavities, such as the gullet (oesophagus) or rectum. A sterile probe that can be heated (a thin wire or hollow tube filled with water) is placed inside the cavity where the tumour is. This heats the affected area.

Interstitial hyperthermia This is used to treat tumours which are deep within the body, such as brain tumours. Under anaesthetic, probes or wires are placed within the tumour tissue and then heated. This method allows tumours to be heated to a higher temperature than external techniques.

How local hyperthermia treatment is given

You will lie on a bed or treatment couch and have a local anaesthetic to numb the area. Temperature monitors are applied to the area around the tumour. Thin plastic tubes (catheters) are then inserted into the tumour and small thermometers are placed inside the catheters.

To control the skin temperature, a water bag is placed on the area to be treated. The applicator (a small metal box which contains microwave radiators) is placed on the water bag. You will be awake during the procedure and asked to remain fairly still. During the treatment, members of staff are always nearby and will come and make adjustments to the position of the applicator. Each treatment can take up to an hour and a half.

During treatment, the staff will aim to get the temperature in the tumour as high as possible without damaging nearby tissues. The temperature will be measured continually and will be increased as long as you are comfortable. If you feel symptoms such as a burning sensation or a feeling of pressure on the area being treated, it is important you tell a member of staff. It may be that the temperature is too high and needs adjusting.

You might find that your whole body temperature starts to increase during treatment. You will be kept as comfortable as possible with air conditioning, wet towels and extra ventilation.

If you are having treatment for a tumour deep within the body, you will have your blood pressure and heart rate (pulse) monitored regularly and your temperature will also be checked.

You can have a relative or friend with you in the room during the procedure. If your companion has a pacemaker or is pregnant, however, they are not allowed to stay in the treatment room.

Possible side effects

Generally hyperthermia treatment is tolerated well with few side effects or complications.

During treatment you may feel a sensation of heat (like a hot water bottle). Heat applied directly to the skin can cause discomfort. It can also cause blisters, which usually heal within a few weeks.

Increasing the temperature of the treatment may cause the skin to burn or may cause muscle tenderness. The burn might result in a firm, tender spot below the skin. It will heal and usually the tenderness will disappear within a few days. This may cause problems, however, if you need further hyperthermia treatment.

Often people feel very tired after treatment. Usually the tiredness disappears after a few hours or following a night's sleep.

Skin care

If blisters develop during the treatment, it is important to treat the area with care. Try not to get the area too wet and avoid soaps, talcum powder and deodorant. Do not apply creams or dressings unless they have been prescribed or recommended by your specialist. Staff at the hospital will be able to give you advice on how to look after your skin.

Hyperbaric oxygen (HBO) therapy

2007-06-30T03:31:00.000-07:00

This information is about the use of hyperbaric oxygen therapy (HBO) for people with cancer. HBO therapy is sometimes used to treat a number of severe side effects of treatment for cancer.

HBO therapy
What HBO therapy is used for
How it works
HBO therapy use in cancer
When HBO therapy is used
How HBO is given
Possible side effects
Less common side effects

HBO therapy

Hyperbaric oxygen therapy is a form of treatment which involves providing the body with extra oxygen. 'Hyper' means increased and 'baric' relates to pressure. Oxygen (O2) is one of the gases in the air that we breathe, and is essential for life. The air that we breathe normally contains 21% oxygen.

In HBO therapy, more oxygen is forced (pressurised) into normal air. (This can only be carried out in special chambers called hyperbaric oxygen chambers). People can breathe this increased oxygen by sitting in the chamber and using a mask or a hood.

Hyperbaric oxygen chambers were originally designed to treat deep sea divers for decompression illness (the 'bends'), and to treat severe carbon monoxide poisoning.

What HBO therapy is used for

HBO therapy can help in a number of different situations where body tissues have suffered from a decrease in oxygen levels. These include:

decompression illness (divers who suffer from the bends)
severe carbon monoxide poisoning
smoke inhalation
chronic wounds and some infections
wound healing after reconstructive surgery
radiation necrosis (body tissue dying off after radiotherapy treatment)
acute blood loss where a blood transfusion is not possible (for Jehovah's Witnesses)

How it works

Oxygen is carried around the body by the blood. Breathing in 100% (pure) oxygen, under increased pressure (HBO), allows extra oxygen to be forced into the blood stream and dissolved at a far greater rate than if pressure was not used. This extra oxygen can help where healing is slowed down by infection or limited blood supply due to damage to the tissues. HBO therapy:

encourages new blood vessels to grow and carry additional blood
increases the ability of the body's defence mechanisms to fight infection and kill bacteria
helps reduce any swelling that may occur around the area

HBO therapy use in cancer

Radiotherapy treatment for cancer can cause changes in the oxygen supply to tissues in the treated area. This is because radiotherapy affects normal cells and blood vessels as well cancer cells.

The small blood vessels in the treated area can be damaged by radiotherapy treatment, causing less blood to be supplied to that area. When this happens, it becomes more difficult for essential oxygen and nutrients to reach the tissues. Over a period of time, these affected tissues may deteriorate and become fragile. The tissues may break down and form areas of ulceration and, although not common, some tissues may eventually die off completely (radiation necrosis). These radiation injuries can occur very slowly over a number of months or even years.

Although HBO treatment has been available for a long time, its use for these effects of cancer is relatively new. More research into the use of HBO in treating the long-term side effects of radiotherapy is needed before it becomes more widely used in the UK. However, previous studies have suggested that HBO may be effective in the following conditions.

Chronic lymphoedema in breast cancer

Radiotherapy is often given after breast conserving surgery for breast cancer. A potential side effect of radiotherapy to the breast and armpit is lymphoedema (especially if all the lymph nodes have been surgically removed).

Lymphoedema is a swelling in the arm because of an abnormal collection of lymph in the body’s tissues. It can also cause pain and redness (erythema). It is thought that HBO therapy may help these symptoms by reducing the swelling in the area. Research trials are looking at how effective HBO therapy is in treating lymphoedema.

Chronic radiation cystitis

Radiotherapy is used as a treatment for some types of pelvic cancer. Sometimes treatment can lead to chronic cystitis (inflammation of the bladder tissues). Symptoms include urinary frequency (needing to go a lot), pain when passing urine, and blood in the urine (haematuria). These problems can occur months or years after treatment. Symptoms can be persistent and range from moderate to severe. HBO therapy may be used to help relieve things when other forms of treatment have been tried without success.

Osteoradionecrosis

Radiotherapy is often used for cancers in the head and neck. The tissues around this area are fragile and may break down after radiotherapy, particularly if previous surgery has been carried out. Although it is rare, the bone itself can be affected by radiotherapy and start to break down and die. This is known as osteoradionecrosis. It can also happen when radiotherapy is given to other areas of the body, such as the chest or the pelvis.

Treatment for osteoradionecrosis includes antibiotics, ‘washing-out’ the area with salty water (saline irrigation), and sometimes surgery to remove some or all of the affected bone. Although HBO therapy cannot restore the dead bone, increased oxygen can help the tissues around the area to heal by encouraging blood vessels to grow. HBO therapy can also be given before reconstructive surgery to help the healing process and prevent infection. If wounds or tissue are infected, treatment would usually consist of medicines or surgery as well as HBO therapy.

Tooth removal

Having a tooth removed shortly before, during or after radiotherapy treatment to the mouth and jaw area may increase the risk of osteoradionecrosis. This is because of the reduced oxygen supply to the area. HBO therapy can be given as a preventative measure, if used both before and after the tooth extraction, to stimulate the healing process.

Chronic radiation proctitis

Radiotherapy can be given for pelvic and bowel cancer. The rectum is very sensitive and although rare, long-term symptoms due to radiation damage can occur. These include pain, bleeding and irregularity in bowel habits. If these symptoms do not improve following treatments such as anti-inflammatory medicines, HBO therapy may be helpful.

When HBO therapy is used

Your doctor can refer you for HBO therapy if you have long-term side effects of radiotherapy that have not responded to normal treatment. Your consultant can advise you whether HBO therapy is appropriate in your situation.

HBO therapy is not always offered as a routine treatment for radiation damage, as it is a fairly new treatment in cancer care and knowledge about the potential benefits is not widespread. You can be referred for treatment by your GP or hospital specialist. Treatment is only offered at specialised centres throughout the UK, so you may have to travel some distance.

Before having HBO therapy you will be examined by a doctor to make sure that you are fit to receive this type of treatment. HBO therapy is not suitable for all people, and is not advised if you are pregnant, suffer from fits, or have severe chest disease or problems affecting your ears or sinuses. Treatment is not recommended if you have a fear of enclosed spaces (claustrophobia).

If you smoke, you may be asked to stop smoking before and during treatment as this is likely to affect the oxygen levels.

How HBO is given

Treatment is usually painless and is carried out in specially-designed chambers. There are two types of chamber: a monoplace chamber and a multiplace chamber.

A monoplace chamber is designed to treat one person at a time and involves lying on a 7ft padded stretcher that slides into a clear plastic tube (chamber) about 2ft wide. Once you are inside, the door is closed and the chamber is pressurised. You will be able to see and talk to a member of staff at all times during the treatment.

Multiplace chambers are designed to hold and treat several people (up to 12) at a time, and are more commonly used. These chambers are quite large and you will be able to walk about inside. Once you are sitting or lying inside the chamber, the doors will be closed and air is blown into the chamber to increase the pressure. You will hear a sound similar to that in an aircraft as the air begins to circulate. You will start to feel a sensation of fullness in your ears and will be shown how to ‘clear’ your ears. It is important to do this in order to equalise the pressure in the ears and to help prevent any pain in your ear drum.

When the pressure reaches the correct level, staff in the chamber will help you to put on either a mask or a clear hood to receive 100% oxygen. Trained staff usually stay with you throughout the treatment session and you can talk to staff outside as well should you need anything. You should be able to relax, read, or listen to music.

Near the end of the treatment the pressure in the chamber is gradually decreased over a period of time. You may feel popping in your ears during this time. After the decompression phase you can leave the chamber.

The length of each treatment varies depending on what you are being treated for and can last anywhere from 60–150 minutes at a time. Treatments are usually repeated over a number of days, or several weeks. For maximum benefit the entire course should be completed.

Treatment sessions are likely to be postponed if you are suffering from colds or flu, runny nose, cold-sores, nausea, vomiting or are generally feeling unwell. You should let your nurse or doctor know if you have any of these symptoms before starting a treatment session.

Possible side effects

HBO therapy is a relatively safe treatment with few serious side effects. Any side effects are usually minor and short lived. We have outlined the most common and less common side effects so that you can be aware of them. If you notice any other problems which you think may be due to the treatment, please discuss them with your nurse or doctor.

Blurred vision can occur after having multiple treatments and is due to the development of short sightedness (myopia). The effect usually comes on gradually and then gets better slowly when treatment ends. Temporary use of glasses or a change in prescription may be helpful, but the blurred vision only lasts a few weeks at most.

Light-headedness Some people feel light-headed after treatment. This only lasts for a few minutes.

Fatigue Tiredness is a side effect which can be more of a problem if you have treatment more than once a day. The effect usually wears off after a few days once the treatment sessions are finished.

Less common side effects

Ear problems Although rare, damage to the middle ear can occur due to the change of pressure. This can cause pain in the ears and bleeding if a rupture occurs. You will be shown how to equalise the pressure in your ear during treatment, which can help to prevent any ear problems.

Sinuses The change in pressure may cause congestion of sinuses, leading to headaches or facial pain. Usually this can be controlled with decongestant medicine but occasionally HBO therapy needs to be stopped.

Individual hormonal therapies by brand name

2007-06-30T03:23:00.000-07:00

On this blog, drugs are referred to by their generic names. Sometimes, however, they are more commonly called by a brand name. This is an alphabetical list of brand names for hormonal therapies with links to the relevant information.

Hormonal therapies: Overview

2007-06-30T03:14:00.000-07:00

Hormones are substances that occur naturally in the body. They act as chemical messengers influencing the growth and activity of cells. Hormones are produced by a number of different organs or glands which together are known as the endocrine system.

Hormonal therapies act by altering the production or activity of particular hormones in the body. They are most commonly used to treat breast and prostate cancer. The type of hormone therapy given depends on the type of cancer being treated.

There are several different types of hormonal therapy. Our section on individual therapies provides more detailed information about each particular treatment.

patient information guide: Hormonal therapies

Book

Tamoxifen and breast cancer
Author	DeGregorio, Michael and Wiebe, Valerie J
Publisher	Yale University Press
Description	This book covers the history and evolution of breast cancer, how tamoxifen works, what the side effects are and why tamoxifen treatment is unsuccessful in some women.
ISBN	0300079516
Date	2000

Booklets and factsheets

Arimidex (anastrozole)
Author	Breast Cancer Care
Description	Factsheet no 19
Obtain from	Breast Cancer Care, Kiln House, 210 New King's Road, London SW6 4NZ Tel: 0808 800 6000 Email: info@breastcancercare.org.uk
URL	http://www.breastcancercare.org.uk/home

Aromasin (exemestane)
Author	Breast Cancer Care
Description	Factsheet no 30
Obtain from	Breast Cancer Care, Kiln House, 210 New King's Road, London SW6 4NZ Tel: 0808 800 6000 Email: info@breastcancercare.org.uk
URL	http://www.breastcancercare.org.uk/home

Individual hormonal therapies
Author	Cancerbackup
Description	Various factsheets
Obtain from	Online versions available Order from Cancerbackup

Tamoxifen
Author	Royal Marsden NHS Trust
Description	Leaflet
Obtain from	Hochland and Hochland Publications Ltd, 174A Ashley Road, Hale, Cheshire WA15 9SF Tel: 0161 273 4156 Fax: 0161 929 1818

Zoladex (goserelin)
Author	Breast Cancer Care
Description	Factsheet no 21
Obtain from	Breast Cancer Care, Kiln House, 210 New King's Road, London SW6 4NZ Tel: 0808 800 6000 Email: info@breastcancercare.org.uk
URL	http://www.breastcancercare.org.uk/home

Alternative therapies

2007-06-28T08:51:00.000-07:00

General information about alternative therapies
Essiac
Cow or shark cartilage
Metabolic therapy
Immuno-augmentative therapy

General information about alternative therapies

Alternative therapies means therapies which try to treat cancer with unconventional therapies instead of the usual medical methods. Although practitioners of these therapies may make claims that they can cure cancer or that they are effective in controlling symptoms, they cannot. Some alternative therapists use their therapies for people having conventional medical or complementary therapies.

Some alternative therapists advise that patients should give up conventional therapy to use alternative therapies. This can mean that patients with early cancer may miss out on treatments that could offer them a cure, and people with advanced cancer may miss out on conventional medicines that could control or reduce their symptoms.

Some therapies can be harmful and cause severe side effects. If you are thinking of trying an alternative therapy it is essential to talk to your cancer doctor or specialist nurse beforehand.

There are literally hundreds of alternative therapies – they include:

Some dietary therapies such as Gerson therapy (see Diet)
Alternative medicines
Megavitamin therapy
‘Immuno-augmentative' therapy
Cleansing therapies – such as intravenous hydrogen peroxide

Extravagant and sometimes convincing claims have been made about some alternative therapies in this section: for example, that they can cure cancer. However, there is no evidence that they can do so.

Essiac

'Essiac' is a herbal remedy originating from the Canadian native tribe, the Ojibwa. It was first publicised by a Canadian nurse called Renee Caisse. She named the remedy after herself - 'essiac' is her surname spelled backwards.

Essiac is a mixture of roots, bark and leaves, including burdock, sheep's sorrel and slippery elm. The mixture is boiled to form a brown liquid, which is taken as a drink. It is claimed to be a cure for cancer. Essiac is usually sold as a nutritional supplement. There have been reports over the years of cancers completely disappearing, although in many cases, it has been found that either the diagnosis was wrong in the first place, or that conventional cancer treatment is more likely to have been the 'cure'.

Essiac has been tested in trials in Canada and in the USA. The National Cancer Institute in the USA advises that Essiac does not appear to have any anti-cancer effect in the body, although it does not seem to do any harm either.

If you are interested in trying Essiac, talk to your doctor, as it can sometimes be used alongside your conventional cancer treatment.

Cow or shark cartilage

Cartilage is sold as a food supplement, rather than as a drug. It is taken as capsules or as a powder. Occasionally it is given as an injection just under the skin or as an enema (liquid passed into the back passage). The cartilage (tissue found between bones and joints) is taken from cows or sharks. In theory it is supposed to work by blocking the development of new blood vessels and starving the cancer. So far, scientific studies and trials have shown no evidence that it prevents or cures cancer. Doctors and researchers recommend that cartilage should only be taken as a cancer treatment as part of research trials. Cartilage therapy can cause side effects such as nausea and vomiting in some people.

Metabolic therapy

Metabolic therapy claims to boost the immune system. Metabolic therapists say that they diagnose abnormalities at the cellular level and correct them by normalising the patient's metabolism. They regard cancer, and other 'degenerative' diseases as the result of metabolic imbalance caused by a build up of 'toxic substances' in the body. They claim that they can treat the cause of the disease by removing 'toxins' and strengthening the immune system so the body can heal itself.

Metabolic treatments vary from practitioner to practitioner and may include a 'natural food' diet, coffee enemas, vitamins, minerals, enzymes, or chemicals. These are said to flush toxins out of the body, allowing it to heal. However, there is no research evidence suggests that these help in the treatment of cancer.

The most commonly used metabolic therapy in the UK is lætrile (amygdalin or vitamin B17), a derivative of bitter almonds. There are many websites which promote lætrile as a substance that can cure cancer, however, studies giving lætrile to people with cancer have not shown that it can help to control or cure cancer. Some websites promoting lætrile advise that people taking it should not use any other type of cancer therapy. This is very worrying as for many people with early cancer, conventional treatment may cure it. If you are thinking of taking lætrile therapy, it is best to discuss this with your cancer specialist or one of the organisations listed.

Immuno-augmentative therapy

There are several different types of immuno-augmentive therapy. They are aimed at training the patient's own immune system to recognise and destroy cancer cells. However, none have been shown to have any effect on cancer and they can be very, very expensive.

One type of therapy used in Europe to boost the immune system in people with cancer is Iscador: an extract of mistletoe. It has been used by homeopathic doctors for patients with cancer (although it is actually a herbal medicine). It can be taken as tablets or by injection and a course is prescribed. However, no reliable studies have shown that it has had any effect on the progress of cancer in patients.

Diet and cancer

2007-06-28T08:50:00.000-07:00

Diet and cancer
A healthy diet
The Bristol diet
Alternative diets
Possible problems
Emotional effects
Vitamins, megavitamin therapy and cancer
The Gerson diet
Nutritional therapists

Diet and cancer

There are several well-established links between diet and the causes of cancer. In general, fresh fruit and vegetables and high-fibre diets are good for you and can reduce the risk of getting cancer. Diets based more on fish and chicken and less on red meat may also reduce the risk. A high intake of smoked food may slightly increase the risk of some cancers. It is thought that diet plays a part in the development of up to a third of all cancers. However, there is no scientific evidence that once you have got cancer, eating a particular diet can treat the cancer or reduce the risk that it may come back.

Although diet cannot cure or control cancer, eating a healthy diet can improve general health and can help to give people a sense of control over their life and their future, which can be very beneficial. Your doctor, specialist nurse or dietitian can give you advice on healthy eating.

Whether or not you decide to change your diet may also be affected by your family's views. Families who are coping with the stress of a relative with cancer may add to the pressures on themselves by suddenly becoming vegetarians, or trying to get used to herbal teas. It is important to balance your doctor's or dietitian's advice with common sense.

A healthy diet

The basic principles of a healthy diet are:

Watch your weight

Try to maintain your weight within the normal range for your height (your GP can advise you on your ideal weight).
eat plenty of fresh fruit and vegetables

eat foods high in fibre – such as wholemeal bread and grains
eat more fish and chicken and less red meat
eat less fat
eat less sugar and salt
have only moderate amounts of tea and coffee
take time to eat slowly, peacefully and with enjoyment.

Be sensible with alcohol

Current sensible drinking guidelines recommend that:

men drink no more than three units of alcohol per day, or 21 per week
and women drink no more than two units per day, or 14 per week.

One unit of alcohol is the equivalent of a small glass of wine (125ml), half a pint of standard strength beer or lager, or a single measure (25ml) of a standard strength spirits.

These guidelines do not apply to people who have lost a lot of weight. They may need to eat whatever foods they can manage in order to get enough calories and protein. There may be times when someone with cancer wants to eat foods that are considered unhealthy but are very enjoyable. In this situation it is sensible not to be too rigid about a healthy diet.

Many complementary therapists do not recommend strictly vegan or vegetarian diets but are convinced that a good diet can be helpful. They create special diets, with the help of the person with cancer, which are as nutritious and enjoyable as possible.

The Bristol diet

The Bristol diet, developed at Penny Brohn Cancer Care (formerly Bristol Cancer Help Centre), is a type of complementary diet therapy. It is perhaps the best-known diet in the UK for people with cancer. The emphasis of this diet is on wholefoods; fresh fruit and vegetables; raw cereals; and organic fish, poultry and eggs. The diet stresses the avoidance of dairy produce such as milk, cheese and yoghurt, red meat, salt, sugar and caffeine (e.g. tea and coffee) and encourages the use of organically grown produce.

The diet can be modified to a person's individual needs, and the guidelines recommend that changes should be made gently and without pressure. They emphasise that eating should be enjoyable and not stressful. You can get information about the Bristol diet from Penny Brohn Cancer Care.

Alternative diets

There has been a lot of publicity about alternative diets for treating cancer over the past few years. Some alternative diets claim they rid the body of toxins that accumulate from the food we eat in the Western world. Many of these dietary therapies are strictly vegan or vegetarian. They involve eating food that is raw, sugar-free and low in salt. Sometimes, vegetable/fruit/liver juices and high doses of vitamins/minerals/enzymes may be used. Some recommend taking large doses of vitamins.

Many dramatic claims for cures of people with advanced cancer have been made and it is completely understandable that people with cancer should be attracted to diets which seem to offer the hope of a cure. However, there is no scientific evidence that alternative diets can make a cancer shrink, increase a person's chance of survival or cure the disease. As these diets have not as yet been properly studied, their real effect is uncertain.

There is increasing evidence that the right diet can help to reduce the risk of cancer. However, there is no scientific evidence that cutting out key elements of a normal diet, as some diet therapies advise, will improve the outcome for people once they have cancer.

Possible problems

Cancer doctors and dietitians are concerned that many alternative diets are completely inappropriate for most cancer patients. They can be high in bulk, and low in calories and protein, which can cause weight loss. Weight loss may be a particular problem if people have already lost weight from the cancer itself or its treatment. They then need all the protein and calories they can get, from whatever source.

Some people get pleasure and satisfaction from preparing these special diets, but others find them quite boring and even unpleasant to eat and time-consuming to prepare. Some of the alternative diets are very expensive. Some may even be harmful to people with cancer.

Emotional effects

People can also feel very angry and let down if they are led to believe that a particular diet will cure or control their cancer and this does not happen. They can also feel that they are to blame for not following the diet properly or because they did not believe in it enough.

It can be very confusing to be faced with conflicting advice about what to eat, but most doctors and specialist nurses recommend a well-balanced diet and one that you enjoy.

If you have any queries about alternative diets, or are thinking of following one, get further advice from your doctor, specialist nurse or dietitian.

Vitamins, megavitamin therapy and cancer

As the body cannot make vitamins in large enough amounts, they are an essential part of a healthy diet. Tiny amounts of certain vitamins help to protect the body from cancer. Therapists who recommend very large doses of vitamins (megavitamin therapy) in both preventing and treating cancer have tended to assume that if a little of a vitamin will do you good, a lot will be even better. However, there is no evidence that taking large doses of vitamins is helpful in treating cancer and recent research has shown that high doses of vitamins may be harmful.

The best way to get the vitamins and minerals you need is by eating a healthy diet.

The vitamins most often used in megavitamin therapy are vitamins A, C and E.

Selenium is a mineral trace element which can be found in brazil nuts, grain, fish and meat. There is some suggestion that selenium may protect against cancer. However, it is poisonous if taken in large doses.

Vitamins used in megavitamin therapy

Vitamin A There is some evidence to suggest that vitamin A may have a protective action in some forms of cancer. However, very high doses can be harmful.
Vitamin C Vitamin C is the most popular of the vitamin supplements used for cancer. It is said to reduce the spread of cancer cells and boost the immune system, but this has never been proved.
Vitamin E This is also thought possibly to help prevent cancer. But as yet there is no reliable evidence to suggest it can help treat cancer.
Vitamin Q10 is also sometimes used in this treatment. It has been suggested that there are molecules in the body called free radicals, which may damage cell membranes, and that these changes to the cell membrane are part of the development of cancer. It has been claimed that vitamin Q10 prevents this damage. However, there is no scientific evidence to support such claims.

The Gerson diet

The Gerson diet was created by a German doctor: Dr Max Gerson. He claimed a 50% recovery rate with his diet, even with people who were terminally ill, but there is no evidence at all to support this. The diet itself is strictly based on organic fruit and vegetables, taken mainly as juice prepared with a juice extractor. In addition a number of medications including thyroid hormones and liver extracts are given, and coffee enemas are used to ‘flush out toxins'.

This diet needs a lot of time and commitment and may be expensive to follow. Although there is no scientific evidence to support this, some people say that the Gerson diet has helped to reduce pain or other symptoms of cancer. Following the diet leads to an ‘allergic inflammation reaction' or ‘healing reaction' within 3–10 days. People who have used the Gerson diet have reported the following effects: nausea, vomiting, stomach cramps, a high temperature and headaches. Other possible side effects include perforation or rupture of the large intestine (colon) from using enemas, infections from the enema devices and serious fluid, electrolyte, and vitamin imbalances. The high levels of hormones and extracts used can lead to toxicity and may disrupt the metabolic balance in the body.

Nutritional therapists

Nutritional therapists focus on using diet as part of the healing process. They do not aim to cure a cancer, but try to improve the natural health of the body. A nutritional therapist will assess your general health and recommend a diet that is specific to your needs. There is no evidence that nutritional therapy can cure a cancer or reduce the chance of it coming back.

You can get more information about nutritional therapy and find a registered therapist from the British Association for Nutritional Therapy.

Psychological and self-help therapies

2007-06-28T08:48:00.000-07:00

In this section, several approaches are discussed that have been used to help people cope with stress, anxiety and difficult feelings and emotions. They may be helpful for some people. It can also be helpful to develop open and honest communication between the person who has cancer, their family and friends, and their health professionals.

Talking therapies
Counselling
Group therapy
Self-help groups

Talking therapies

There are many different types of talking therapies available, including psychotherapy and counselling. These have all been shown to benefit people who have anxiety or depression, and can be useful for people affected by cancer. You can ask your doctor to put you in touch with the psychological support services at your hospital.

Counselling

Many people can get support by talking to close family members or friends, but it can sometimes be useful to talk to someone from outside your circle of family and friends, who has been trained to listen and help you explore your feelings. The emotions you are feeling may be very tangled and confused. You may find them difficult to talk about and very hard to share with your friends or family.

Talking one-to-one with a trained counsellor in a more focused way is designed to help you sort out your feelings and find ways of coping with them.

Some GPs have counsellors within their practice, or they can refer you to a counsellor. A national cancer counselling service, The Cancer Counselling Trust, provides face to face counselling for people in London and telephone counselling for anyone outside London. One to one, couples or family counselling is available.

Group therapy

You may be given the chance to take part in group therapy, in which a trained therapist (counsellor or other professional) encourages a group of people to share their feelings and experiences with each other. This is different from a self-help group (see below), as the therapist leading the group will be aware of the individual participants' problems and will be able to guide the discussion so that everyone benefits.

Self-help groups

Organised groups, where people with cancer and their families meet others in a similar situation, can be helpful. Often this is the first opportunity that families have to discuss their experiences with other people living with cancer.

These groups can be a source of information and support and can provide an opportunity for people to talk about their feelings. Some groups are run by health professionals, doctors and nurses, counsellors or psychotherapists in a hospital. More commonly, people with cancer run the groups. They often offer different techniques and coping strategies, together with relaxation or visualisation, as well as practical information and emotional support.

If you are interested in joining a group, but are unsure about whether it would be helpful, you could try making some enquiries about it first, and go to a meeting to see what it is like. You may feel more comfortable if you take a friend or a relative along with you. But if you are uncomfortable with a group situation, you don't have to go again. You may find it more helpful to find someone you can speak with individually on a regular basis to support you.

Complementary medicines

2007-06-28T08:47:00.000-07:00

Homeopathy
Herbal medicine
Flower remedies

Homeopathy

Although homeopathy is not part of conventional treatment for cancer it is often used to try to improve the quality of life of people with cancer as an addition to conventional treatment. Homeopathy has been used for many years for a wide range of illnesses, and the number of people using it to relieve cancer symptoms has steadily increased in recent years.

Homeopaths use homeopathy to help with a range of symptoms caused either by the disease itself or by the side effects of some of the conventional treatments such as radiotherapy and chemotherapy. They aim to help the body to find its own way of healing itself.

Homeopathy is based on the theory that a substance which causes similar symptoms to those of the illness being treated can be used in tiny amounts to treat those symptoms. Homeopathic remedies, which come in tablet form, liquid or creams, contain very diluted forms of these active ingredients.

Some GPs and hospital doctors are trained in homeopathy, and homeopathy is sometimes available through the NHS. If you are interested in this type of treatment you can discuss it with your GP or your cancer doctor.

You can get information about homeopathy and finding a registered practitioner from the British Homeopathic Association or The Royal London Homeopathic NHS Trust.

Herbal medicine

Herbal medicine is the use of plants or mixtures of plant extracts to treat disease. Herbs were commonly used in the UK before the development of modern medicines and they are still widely used by many people for common illnesses. In the UK there are also practitioners of Chinese medicine who use herbs as part of traditional Chinese medicine. The herbs are usually boiled up and drunk as a tea or tincture, but they can also be given as tablets, creams or ointments.

Herbal medicines aim to improve the natural functions of the body and restore a natural balance of health. They may help to reduce symptoms of cancer and the side effects of treatment.

If you are interested in trying herbal medicine, first check that the therapist is properly qualified, then talk to your cancer doctor. Some herbal medicines may contain substances that could be harmful to some people with cancer, such as arsenic, steroids or oestrogen. Some doctors are cautious about patients using herbal medicines because they are unsure of their effects and possible interactions with other medicines you may be taking.

It is important to check out carefully with your doctor any herbal medicines you are thinking of taking, as many herbal remedies are misleadingly promoted as cures for cancer.

You can get more information about herbal medicines and finding a registered practitioner from the National Institute of Medical Herbalists or the College of Integrated Chinese Medicine.

Flower remedies

Bach flower remedies

These remedies are based on the essences of flowers, diluted many times and drunk as a liquid. They are considered to be harmless and some people say that they help to reduce psychological and emotional symptoms. Bach flower remedies can be bought from health-food shops and some chemists. The remedies are often diluted in alcohol and so people who do not drink alcohol may choose not to use them.

You can get more information about Bach remedies from The Doctor Edward Bach Centre.

Other types of flower remedies such as Jan de Vries flower remedies are also available from chemists. They are considered to be harmless, and may help to reduce anxiety and some symptoms for some people.

Physical therapies

2007-06-23T09:03:00.000-07:00

This section discusses eight physical therapies; massage, aromatherapy, reflexology, acupuncture, shiatsu, tai chi, qigong and yoga. These therapies are available to patients in some cancer hospitals for relieving symptoms and reducing anxiety. It is important that if you have these therapies outside the hospital, you always make sure the therapist or practitioner is trained and registered.

Massage
Aromatherapy
Acupuncture
Reflexology
Shiatsu
Tai chi and Qigong
Yoga

Massage

Massage is one of the oldest therapies in existence. It is now often offered as part of cancer care in hospital wards, hospices and some GP surgeries.

Massage is a form of structured or therapeutic touch which can be used to relax, to relieve muscle pain and tension, and to bring comfort through contact with another human being. There are many different types of massage therapy. Some types are soft and gentle; other types are more vigorous and possibly uncomfortable.

Massage can help to reduce feelings of anxiety, hopelessness and despair. Some people worry that massage could cause spread of cancer cells, but research has shown that it is safe for people with cancer to have massage. However, it is important that the massage therapist avoids any area affected by the cancer.

Relatives or friends can be taught to massage the person who is ill, which can reduce anxiety and bring comfort to both people. Massage can be a form of communication between the massager and the patient, as well as relieving pain and muscle tension. As long as you are careful to avoid wounds or scars, vein thromboses (blood clots) and areas of tenderness, and to be particularly gentle if the cancer has spread to the bones, massage for people with cancer is very relaxing.

You can get more information about massage and finding a trained massage therapist from the General Council for Massage Therapy.

Aromatherapy

Aromatherapy is the use of scented natural oils extracted from flowers, plants or trees. The oils are thought to have therapeutic properties. They may be used during massage, but can also be used in special aromatherapy burners or in baths.

Different oils have different effects: for example, an aromatherapist may use cedarwood for a pleasant and relaxing effect, or rosemary for an invigorating and refreshing effect.

Some oils can have physical effects on the body, such as raising blood pressure, so it is important to tell the therapist about any medicines you take and give them all your medical details. If you are having conventional therapy for cancer, for example, chemotherapy, you should always check with your doctor before beginning aromatherapy treatment.

It is not always necessary to remove clothing to have massage or aromatherapy. Often hand and forearm massage or head and neck can be very relaxing.

For more detailed information about aromatherapy and to find a trained therapist, contact the International Federation of Professional Aromatherapists; they have guidelines for aromatherpists working with people who have cancer.

You could also contact the International Federation of Aromatherapists or the Aromatherapy Consortium.

Acupuncture

Acupuncture is based on traditional Chinese medicine. It uses thin, sterile acupuncture needles inserted just below the skin to affect the flow of energy in the body. As well as the circulatory and nervous systems in the body, in Chinese medicine there is also a system of life force (energy) channels. The energy that moves along the channels is known as chi.

Acupuncture needles are placed along points in the energy channels to help release the flow of chi and restore health and balance in the body. Acupuncture can help with all sorts of physical problems such as pain, nausea and a sore mouth, and can also help to reduce fear and anxiety.

A professional acupuncturist may be a member of a team working in a pain clinic. Some doctors are trained in acupuncture. Studies show that during acupuncture the body releases endorphins, natural chemicals which can relieve pain, relax muscles and increase feelings of well being. It may help to reduce hot flushes caused by cancer treatment for some women with breast cancer and men with prostate cancer.

Acupuncture is sometimes used to treat side effects of cancer treatment, such as nausea. Seabands (acubands), which work on a similar principle, by applying pressure to a specific area of the wrist, may also be helpful.

You can get more information about acupuncture and finding a registered practitioner from the British Acupuncture Council or the British Medical Acupuncture Society.

Reflexology

Reflexology is a specialised form of foot or hand massage that is related to the Chinese practice of acupressure. The theory underlying this therapy is that different areas on the sole of the foot or palm of the hand represent and are connected to the body's internal organs.

Systematically putting pressure on points in the feet or hands is thought to stimulate the flow of energy along energy channels in the body. Some people find that symptoms such as pain, constipation and sickness can be relieved. Many people report that reflexology can help reduce tension and pain and may be able to help with some symptoms of advanced cancer and to improve energy levels.

You can get more information about reflexology and finding a registered practitioner from the Association of Reflexologists or the British Reflexology Association.

Shiatsu

Shiatsu is a Japanese form of massage. Like acupuncture it is based on the idea that good health depends on the balanced flow of energy through specific channels in the body called meridians. Pressure is placed on the appropriate meridians to help the person's energy regain its balance. The therapist may also gently stretch or massage areas of the body to reduce stiffness and soreness. Many people find shiatsu relaxing and re-energising, as well as easing pain and other symptoms.

You can get more information about shiatsu and finding a registered practitioner from The Shiatsu Society.

Tai chi and Qigong

Tai chi and qigong are two Chinese philosophies which aim to strengthen the vital force (chi) of the body.

Tai chi (pronounced tie chee) is an ancient Chinese practice that focuses on building strength, balance and flexibility through slow, fluid movements combined with mental imagery and deep breathing. It can improve people's general health.

Qigong (pronounced chee goong) – sometimes spelled 'Chi Kung' – is another Chinese exercise system. Through individual mental and physical exercises, practitioners build up their health and prevent illness by combining discipline of mind, body and the body's 'Qi' (vital force).

Both Tai chi and qigong can help generate a sense of well being and peace and can reduce pain. The slow, graceful movements increase strength and flexibility and improve balance and circulation. They may also relieve some of the side effects of cancer treatment.

You can get more information about Tai Chi or Qigong and local classes from: www.taichifinder.co.uk and www.qi.org

Yoga

There are many different schools and styles of yoga, but they all encourage balanced and holistic development through the practice of yoga postures (asanas), breathing exercises (pranayama) and relaxation techniques.

The Sanskrit word yoga is translated as union between mind, body and spirit, and the practice aims to lead to a better balance of mind, body and spirit. Some types of yoga involve very gentle stretching, movement and meditation. Other types of yoga may involve more vigorous physical movement and dietary changes.

Some hospitals offer yoga as part of their complementary therapy programmes.

You can also get information about local classes from the British Wheel of Yoga.

Mind therapies

2007-06-23T08:55:00.000-07:00

Relaxation
Relaxation exercises
Visualisation (mental imagery)
Hypnotherapy (hypnosis)
Art therapy
Healing
Reiki
Meditation

Relaxation

Simple breathing and relaxation exercises are very useful in reducing anxiety and stress and reducing the harmful effects of stress on the body. Almost everyone can learn the techniques.

They can quickly reduce anxiety and muscle tension and also affect the part of the nervous system that controls blood pressure and the digestive system. Many people with cancer, and their relatives, can be helped to relax and experience a sense of calmness using these simple methods. Relaxation may sometimes be used together with meditation and visualisation.

You can learn relaxation techniques at home using a CD or cassette, or you may be able to join a group. Self-help exercises need motivation and constant practice to give benefit, and it may be easier to stay motivated by attending group classes.

Lying flat may be uncomfortable for people who are breathless or in pain, but many relaxation exercises can be done sitting up or using pillows for support.

Some hospitals and support groups offer relaxation sessions. You can ask if they are provided at your hospital. Cancerbackup can give you details of support groups in your area.

Relaxation exercises

Two simple exercises are described below.

Exercise 1

Find a quiet room where you will be undisturbed for about 10-15 minutes. Undo any tight clothing and take off your shoes, then lie down on the bed or floor. Spend a few moments settling yourself down.Close your eyes, spread your feet 12-18 inches apart and check that your head, neck and spine are in a straight line.

Now focus your attention on your breathing. Do not try to change your breathing for the moment. Become aware of how quickly or slowly you are breathing. Notice whether there are any gaps or pauses between your breathing in and breathing out.

Pause

Now put one hand on your upper chest and one hand on your abdomen (tummy) just below your rib-cage. Relax your shoulders and hands. As you breathe in, feel your abdomen expand. As you breathe out, allow your abdomen to flatten. There should be little or no movement in your chest. Allow yourself a little time to get into a regular rhythm.

Pause

It may help to imagine that as you are breathing in, you draw half a circle with your breath and as you breathe out, you complete the second half of the circle.

Pause

Allow your breath to become smooth, easy and regular.

Pause

Now consciously slow down your breathing out and allow your breathing in to follow smoothly and easily.

Pause

If any distractions, thoughts or worries come into your mind, allow them to come, then allow them to go and bring your attention back to your breathing.

Pause

When you are ready to end this exercise, take a few deeper breaths in. Move your fingers and toes gently.

Exercise 2

Find a quiet room where you will be disturbed for 10-15 minutes. Take off your shoes amd loosen any tight clothing. You can do this exercise sitting, but it is better to lie down on a bed or carpet if you can. The exercise involves tensing and relaxing muscle groups in the body. If some of your muscles are uncomfortable or painful due to your cancer or treatments you have had, you may need to exclude these muscles from the exercise.

Close your eyes gently. Make sure your head, neck and spine are in a straight line. Start by raising your eyebrows and tensing the muscles of your forehead. Hold the tension for a count of five, then relax the muscles and become aware of any difference you feel in the muscles. Repeat once more.

Now squeeze you eyes shut,as tight as you can. Count to five, then release. Notice any difference. Repeat once more.

Open your mouth wide, stretching the muscles of your face. Count to five. Release. Repeat once more.

Tighten the muscles of your jaw, clenching your teeth. Count to five, release and repeat once more. Become aware of all your face and any difference you feel.

Raise your shoulders to your ears, tensing the muscles of your shoulders and neck. Release and relax the muscles. Notice any difference and repeat once more.

Raise your left hand and arm off the floor/bed. Make a fist and increase the tension in your hand, forearm and upper arm. Count to five and let go, allowing the hand to fall back on the floor/bed. Notice any difference between your left and right hand and repeat once more. Repeat the same with the right hand and arm.

Now contract the muscles of the chest. Notice the effect it has on your breathing. Relax. Flatten and tighten the muscles of your stomach. Count to five. Relax and breathe out.

Lift your left foot and leg off the floor by about six inches. Push your foot away from you,tensing the muscles of the foot, leg and thigh. Count to five. Let go and allow the leg to drop down on the floor/bed. Repeat once more on the left side. Then do the exercise twice on the right side.

When you are ready to finish, gently wiggle your fingers and toes - take a few deeper breaths in. Open your eyes gently.

Visualisation (mental imagery)

This is a technique that involves creating images in your mind while you are in a state of relaxation or meditation. For example:

you might imagine that you are lying in a field full of beautiful flowers
that you are healthy and strong
that your healthy cells are knights fighting the cancer cells
or that the suns rays are shining on you, warming you and giving you strength.

The theory is that by imagining a peaceful scene you will encourage yourself to feel more relaxed, and by imagining yourself as healthy you can influence the health of your body. A simple exercise to show how imagination can produce physical changes is to picture a lemon being cut in front of you. Most people who do this will notice that they start to produce more saliva.

Therapists who use creative visualisation in the treatment of cancer have suggested that you can stimulate the immune system to affect the growth of the cancer. Various research studies are being carried out to look at whether visualisation can improve outcomes for people with cancer. Some studies have shown that visualisation or guided imagery can reduce the symptoms of cancer and the side effects of treatment for some people.

Many people report that visualising themselves as stronger helps them to feel better, and they regard it as a form of extended relaxation. Some studies have shown that gentle mental imagery can produce significant improvements in the mood of people having treatment for breast cancer.

Some hospitals and support groups offer guided imagery or visualisation. You can ask if they are provided at your hospital or can contact Cancerbackup for details of support groups in your area.

Hypnotherapy (hypnosis)

Hypnosis is another method which some people find helpful in dealing with the symptoms of cancer. It can be especially helpful in reducing some of the side effects associated with chemotherapy and radiotherapy, such as nausea and vomiting.

In this treatment, the hypnotherapist leads the person into a deeply relaxed state, during which the person is still conscious of their surroundings. The hypnotherapist can then use suggestion to benefit the person in different ways, such as feeling better or gaining some control over symptoms.

You can find out more about hypnotherapy and how to contact a registered therapist from The British Society of Experimental and Clinical Hypnosis or the Central Register of Advanced Hypnotherapists.

Art therapy

This therapy is used to help people to express themselves through working with art materials. The art therapist is usually a psychotherapist and encourages the person to communicate feelings such as fear or anger through painting, drawing or sculpting. The aim is to express feelings rather than produce a work of art. The therapy can be given one-to-one with the therapist or in groups. Through creativity, we can sometimes become aware of and release pent-up feelings. The feelings or emotions can then be discussed, if appropriate, in counselling or group sessions.

You do not need to be able to paint well and you will be encouraged to be spontaneous and doodle. Sometimes the therapist may be more directive and ask you to ‘paint your cancer' or try to capture your relationship with your family. These exercises can help you understand yourself more fully. Art therapy can also be fun and a creative approach to dealing with unhappy and distressing experiences.

You can get more information about art therapy and finding a trained therapist from the British Association of Art Therapists.

Healing

Healers believe that healing energy exists all around us, and that they act as a channel through which healing energy flows into the patient. Healing can provide an important and very valuable support for the person with cancer and his or her family. It may be referred to as spiritual or faith healing if it is used in the context of a religious or spiritual approach to heal the person.

Contact healing may also be known as the laying on of hands in the Christian church.

In therapeutic touch the healer works just above the surface of the body; they believe this affects an energy field that surrounds each person. Some nurses practice therapeutic touch.

You can get more information about healing and finding a healer from the Confederation of Healing Organisations or the National Federation of Spiritual Healers.

Reiki

Reiki (pronounced ray-key) is a Japanese word meaning Universal Life Energy, an energy which is all around us. It is the name given to a system of natural healing which evolved in Japan from the experience and dedication of Dr Mikao Usui. Dr Usui was inspired to develop this healing system from ancient teachings after many years of study, research and meditation. He spent the rest of his life practising and teaching Reiki. Today Reiki is taught and practiced by Reiki Masters who have trained in the tradition passed down from master to student.

A Reiki treatment The recipient simply lies on a couch and relaxes. If they are unable to lie down the treatment can be given in a sitting position, the main thing is for the recipient to be as comfortable as possible. There is no need to remove any clothing. The practitioner gently places their hands non-intrusively in a sequence of positions which cover the whole body. The whole person is treated, rather than specific symptoms. A full treatment usually takes 1-1½ hours with each position held for several minutes.

Reiki treatment is offered in some hospitals and patient support groups.

You can get information about healing and finding a healer from The Reiki Association.

Meditation

Meditation is a way of working with the mind. It uses mental exercises which can help to deeply relax and calm the mind, helping to reduce feelings of fear, pain, anxiety and depression.

Regular meditation practice can help people feel more in control of themselves and their lives. Many studies have shown that regular meditation reduces the pulse rate, lowers blood pressure and reduces the level of stress chemicals in the body.

People who have particular psychiatric conditions such as psychosis may find that some types of meditation make their psychiatric illness worse. It is best to talk to a meditation instructor from an established meditation organisation (and your psychological support team, if necessary) before trying meditation. It is also helpful to practice in a group until you are familiar with the meditation technique. It is also good to talk regularly about your meditation to an experienced meditation practitioner.

Learning to meditate

There are many different types and styles of meditation. One type of meditation practice is described below:

You need to set aside some time - 10-20 minutes early in the morning or before you go to sleep at night. Find a quiet place in your home where you will not be disturbed. It is helpful to keep the same place for meditation as this reinforces the benefits of meditating. It also gives that place in your home a special significance.

The next step is to find a suitable chair or meditation cushion. Meditation is best practised sitting up. Of course you can meditate lying down on your bed, but you are more likely to fall asleep. Meditation is not sleeping - it aims to help you to be alert and awake. However, you can use some types of meditation to help you to go to sleep.

Choose a chair that is comfortable and has a straight back. You may like to support your back with a cushion or pillow. Keep your head, neck and spine erect. If your feet do not reach the floor comfortably, put a small cushion underneath them. If you prefer to sit on the floor, cross your legs in front of you in the most comfortable position and place a small cushion under your bottom.

Put your hands on your thighs. Be aware of your breathing. Spend a few minutes focusing your attention on your breath. Just breathe naturally - you do not need to try to control your breathing. Turn your attention to your forehead. Relax the muscles of your forehead. Relax the muscles of your eyes. Relax the muscles of your face. Check that your jaw is not too tightly closed and that your tongue is lying easily in your mouth. Relax your shoulders.

Relax your hands and fingers. Relax your chest and abdomen. Relax your thighs, knees, ankles and feet.

Bring your attention back to your breathing. Let the breath become smooth and even.

Pause

Now as you breathe in, the the word 'so' on your breath, silently, without moving your lips. As you breathe out, place the word 'hum' on your out breath, silently, without moving your lips. Continue to breathe smoothly and evenly, repeating the sounds 'so' and 'hum' as you breathe in and out. If any thoughts, worries or distractions come into your mind, allow them to come and then go, bringing your attention back to you breathing and the sounds 'so' and 'hum'. Continue for another 5-10 minutes, repeating the sounds internally in time with your breathing.

When you are about to stop, gently move your fingers and toes. Take a few deeper breaths in and out.

Some hospitals and support groups offer meditation sessions. You can ask if they are provided at your hospital or can contact Cancerbackup for details of support groups in your area.

Types of Therapies

2007-06-23T08:52:00.000-07:00

This section gives information about some of the most popular and widely available therapies used by people with cancer in the UK. These therapies are available in many cancer treatment centres and are now often seen as part of conventional support for many patients. The therapies may be able to help people feel better and reduce symptoms or emotional distress caused by cancer. Some therapies may be able to reduce side effects caused by cancer treatment.
:

Feelings, personality and cancer

2007-06-23T08:49:00.000-07:00

There has been a lot of interest and research into the relationship between cancer, emotion, stress and psychological factors in the last 20 years. Research studies have looked at the following questions:

Are people with particular personality types more likely to get cancer?
Can stress cause cancer?
Can attitude affect cancer?
Can changing my attitude and level of stress affect the outcome?

Are people with particular personality types more likely to get cancer?

Although the idea has been popular for a long time there is no scientific evidence to show that people with certain personality types are more likely to get cancer. People with cancer may understandably be anxious and depressed but this does not mean that the two things are linked. In fact, people who are told this, may feel that they are to blame for their cancer, which can cause them unnecessary distress.

Can stress cause cancer?

Many people believe that their cancer was caused by the stress of a traumatic event, or being exposed to stressful situations over a long period of time. It is very difficult to research whether stress can cause cancer, as what causes stress in one person may not be seen as stressful for another. It is very subjective. At the moment, studies have shown that psychological and environmental stress can result in slight changes to the body's immune system, but there is no evidence that this can cause cancer or affect its growth.

Can attitude affect cancer?

Some people feel that a positive attitude helps when people have to cope with cancer and its treatments. However, a positive attitude means different things to different people. So, this does not mean that you have to be cheerful all the time. Everyone who has cancer can feel helpless, and may feel too tired to be positive and 'fight' the cancer. This does not mean that they lower their chance of a good outcome from treatment. It is important to talk to your doctor or nurse if you feel anxious or depressed as help is available for your psychological as well as your physical needs.

Whether or not reducing stress can actually improve prognosis is impossible to prove, but there is good evidence that a positive attitude improves a person's quality of life. However, trying to be positive should not become a burden. Very few people are optimistic all the time, and it is natural and understandable to feel down sometimes.

Can changing my attitude and level of stress affect the outcome?

Anything that helps you cope in your own way is valuable. Books such as Love, medicine and miracles by Bernie Siegel work on the principle that a change in attitude to having cancer may affect the outlook. This idea influences many complementary approaches to cancer. The effect of these approaches is very difficult to evaluate properly, but many people find them helpful and they can contribute to people's sense of wellbeing and quality of life.

Summary

Many people who have cancer find that complementary therapies are very helpful to them in a number of ways. People using complementary therapies may feel more positive about themselves and about their illness. They may be able to cope better with the physical symptoms and side effects of treatment, and with the complex and often distressing emotions that cancer can bring.

If you are considering using alternative therapies or diets always discuss this with your doctor, specialist nurse, or one of the nurses at Cancerbackup.

Choosing a complementary therapist

2007-06-23T08:44:00.000-07:00

If you are considering using complementary therapies, the following suggestions may help you:

Always use a qualified therapist who belongs to a professional body. The organisations listed in this section can give you names of registered therapists and advice on what to look for.
Check the cost of treatment beforehand to make sure you are being fairly charged. The organisations listed should be able to give you an idea of what is usual. Some therapies can be very expensive, but many complementary therapies are provided free of charge by the NHS, and some meditation or relaxation organisations provide free sessions. Many yoga classes are reasonably priced.
Ask the organisation what level of qualification and training practitioners must have before they are allowed to register.
Ask the practitioner how many years of training they've had and how long they've been practising.
Ask if they have indemnity insurance (in case of negligence).
Check if the organisation has a code of practice and ethics, and also a disciplinary and complaints procedure (the better complementary organisations will have this).
Talk it over with your doctor or nurse and ask for their advice, especially if you are going to have a therapy which involves taking pills or medicines.
Ask your doctor or nurse if there are complementary therapies available at your treatment hospital, or through your GP's practice, or if they can recommend any therapies or practitioners.
Choose the complementary therapy that suits your individual needs. If you are not sure and would like to know what other patients have found helpful, contact a patient support group. Support groups often offer complementary therapies.
Don't be misled by promises of cures. No reputable therapist would claim to be able to cure cancer.

Conventional, complementary and alternative therapy

2007-06-23T08:33:00.000-07:00

There is a difference between complementary therapies and alternative therapies, although often these terms are used as though they mean the same thing.

Conventional treatment
Complementary therapies
Alternative therapies
If cancer can't be cured
Talking about therapies

Conventional treatment

Conventional therapies are the treatments that doctors use as part of medical care to treat people with cancer. These consist of surgery, radiotherapy, chemotherapy, hormonal therapy and biological therapies. They are also referred to as orthodox treatments. These treatments are usually tested using scientific reasoning and research methods to prove their benefits and possible side effects.

Complementary therapies

Many people in the UK use complementary therapies regularly to maintain their health. They can be very helpful in dealing with health problems. Some complementary therapies have developed based on ancient traditions and philosophies, using views and experience developed over thousands of years.

In many cancer hospitals and hospices in the UK, complementary therapies are used alongside conventional treatment. Most doctors are happy for their patients to use complementary therapies in this way. There are many different types of complementary therapy and it is not possible to describe them all in this secton. However, see types of therapies for information on therapies commonly used in the UK.

Some doctors have been reluctant for their patients to use complementary therapies, because many of these treatments have not been scientifically tested by Western medical researchers. However, recent research studies have been able to show positive effects from some complementary therapies; such as an improvement in patients' quality of life and reduction of symptoms or treatment side effects.

These therapies are now offered on the NHS in some hospitals. Studies to evaluate and research complementary therapies are ongoing and will help to develop knowledge about the best way to use complementary therapies.

Alternative therapies

Alternative therapies are treatments that try to treat cancer with unconventional therapies (not the usual medical or complementary treatments). Some alternative therapists use their therapies for people having conventional medical or complementary therapies. Other practitioners advise their patients to give up conventional treatments, which can be a very harmful thing to do. Some alternative therapies cause severe side effects and make people feel extremely unwell.

There are literally hundreds of alternative therapies. Some alternative therapists claim that their therapies can cure cancer even if conventional medicines have not been able to do so. However, alternative therapies cannot cure cancer or slow the growth of cancer and some can be harmful. There have been cases in which false claims made about alternative therapies have led some patients to turn away from conventional treatments that could have helped them.

Some alternative therapies are very cleverly marketed so that when you read about them or are told about them, they seem to be very effective. The claims made about some therapies may give patients false hope. People with cancer can be very vulnerable, especially if they have been told that their cancer cannot be cured with conventional therapies. There have been cases where people have been misled and harmed by promises of a miracle cure. However, no reputable therapist would claim to be able to cure cancer.

There are various reasons for people wanting to try alternative therapies. Sometimes it is because people feel that conventional treatment cannot help them or is harmful. This is understandable, as many chemotherapy drugs are toxic and can cause unpleasant side effects. The idea of having radiotherapy can also be frightening. However, in early cancer many people can be cured with conventional treatments.

If cancer can't be cured

If people are told by their doctors that their cancer cannot be cured using conventional medicine, they may feel desperate and feel that an alternative therapy is their only hope of a cure. However, if a cancer cannot be cured by conventional medical treatment it will not be possible to cure it with alternative treatment. In this situation, some alternative therapies may do no harm, but some could be very harmful. If the cancer cannot be cured, complementary therapies can help to reduce anxiety and control symptoms, alongside conventional medicines for symptom control.

If you are considering using complementary or alternative therapies talk to your doctor for advice and support. Doctors are generally supportive of people using any complementary therapies which may help them cope better with their illness, but may advise against using alternative therapies.

Talking about therapies

Before making any decisions on complementary therapies, make sure you have all the information you need from your doctor. You can ask to have an initial consultation with a complementary therapist to ask what they feel their therapy can do for you. See tips on choosing a therapist and what to ask them.

You can take a friend or relative with you for support. It can help to write down the questions that matter most to you beforehand. You can then take time to decide whether you want to go ahead with treatment and think about what is the best option for you.

Our cancer support service can give you advice on how to find a suitable therapist and provides information on different complementary and alternative therapies as well as support groups offering complementary therapy services in your area.

Cancer and complementary therapies

2007-06-19T22:15:00.000-07:00

This section gives information about the complementary therapies most often used by people with cancer. Many people with cancer use complementary therapies to help support themselves through cancer and its treatment.

How complementary therapies can help
Types of therapy
Choosing a therapy and therapist
Cost

How complementary therapies can help

People often speak of feeling that they have lost control of their life when they have cancer. It may be bewildering to spend time in hospitals, which can seem frightening and impersonal, and to meet so many different health professionals, as well as coping with the high-tech machinery and techniques used in cancer treatment. At the same time, it can be difficult to cope with the implications of the illness itself.

Complementary therapists usually work with the person as a whole, not just the part of the body with the cancer. This is called a holistic approach and is something good medical practitioners also do. A complementary therapist who listens and cares may help you cope with some of those difficult feelings, which can be an effective way of getting back some control.

Some hospitals and hospices provide complementary therapies as part of cancer care, alongside conventional cancer treatments such as chemotherapy or radiotherapy. Complementary therapies can:

help you feel better and improve your quality of life
improve your general health
give you a sense of control over what is happening to you
reduce stress, tension, sleeplessness, anxiety, depression and make you feel more relaxed
help to reduce the symptoms of cancer, such as pain, feeling sick, breathlessness, constipation, diarrhoea, tiredness and poor appetite
help to reduce some of the side effects of cancer treatment.

There may be complementary therapies that are not suitable if you have a particular type of cancer or during a particular treatment. It is important to tell your hospital specialist if you are having some form of complementary therapy. It is also important to tell your complementary therapist that you have cancer.

Types of therapy

There are many different types of complementary therapy. It is not possible to describe them all in this section, but we have described the common ones - see types of therapies. We hope this section will give you a balanced view of what is available so that, if you want to try a complementary therapy, you will have a realistic idea of what it will involve and how it may help you.

Choosing a therapy and therapist

It is important to choose a therapy that feels right for you. It is also important that you trust and feel comfortable with the therapist. You may need to try more than one therapist to find someone you feel confident with. Some people find it helpful to use a combination of therapies.

It is important to choose a qualified practitioner. For each therapy mentioned in this section, we give details of an organisation that can help you to find a qualified and registered therapist. See also, tips on choosing a therapist.

Cost

It is a good idea to ask how much a therapy session will cost you before you book, and to get some idea of how often you may need to have the therapy. Some complementary therapies can be very expensive if used over a long period of time.

Some hospitals and hospices offer therapies free of charge or you may be asked to make a small financial contribution. Some cancer support groups offer complementary therapies free or make a small charge. Some private practitioners offer a sliding scale of charges.

Lumbar puncture and intrathecal chemotherapy

2007-06-19T22:11:00.000-07:00

What is a lumbar puncture?
Cerebrospinal fluid
Why a lumbar puncture may be done
Giving your consent
The lumbar puncture
After the lumbar puncture

What is a lumbar puncture?

A lumbar puncture is a procedure in which a hollow needle is inserted between the bones of the lower back into the fluid around the lower part of the spinal cord. A sample of the fluid is then drawn off, to be examined in the laboratory by a pathologist (a doctor who specialises in diagnosing disease by looking at body tissues and cells).

A lumbar puncture is carried out by a doctor or sometimes a specially-trained nurse. It can be done in the outpatients department or on a ward at the hospital.

Intrathecal chemotherapy is where chemotherapy is given into the fluid around the spinal cord during a lumbar puncture.

Cerebrospinal fluid

Surrounding the brain and spinal cord is a watery fluid known as cerebrospinal fluid (CSF). The CSF protects the brain and spine from injury by acting as a shock absorber.

The brain and spinal cord are known as the central nervous system (CNS).

Why a lumbar puncture may be done

There are a number of reasons why a lumbar puncture may be done:

Changes in the CSF can help doctors to diagnose diseases of the brain and nervous system. The fluid that is drawn off is sent to the laboratory where it is examined under the microscope. In some types of cancer, tiny cancer cells can spread into the CSF, affecting the brain and, more rarely, the spinal cord. By taking a sample of the CSF, doctors can see whether it contains any cancer cells.

A lumbar puncture may also be used to inject chemotherapy drugs into the CSF. This can be done for people whose cancer has spread into the CSF, or to help prevent it from happening. Injecting chemotherapy into the CSF is known as intrathecal chemotherapy.

Other reasons for doing a lumbar puncture are:

to measure the pressure of the CSF
to inject a dye so that specialist x-rays can show the structure of the spinal cord
to inject a local anaesthetic (known as an epidural) so that surgery can be performed on the lower part of the body without having to give a general anaesthetic, or to give pain-relieving drugs. These drugs are not injected into the CSF but into other areas, or 'spaces' around the spinal cord.

Giving your consent

Before you have your lumbar puncture, your doctor will explain why it is recommended that you have this test, and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to do the lumbar puncture.

If you are going to have chemotherapy during the lumbar puncture, you will also be asked to sign a form to agree to have this. The lumbar puncture will be done by specially-trained staff and will be in a particular area of the hospital.

Before you are asked to sign the consent form you should have been given full information about:

the procedure and (if needed) the chemotherapy treatment
the reasons for the lumbar puncture
any possible other tests or treatments that may be available
any risks or side effects of the lumbar puncture (and chemotherapy).

If you do not understand what you have been told, let the staff know straight away so that they can explain again. It is not unusual for people to need repeated explanations.

It is often a good idea to have a friend or relative with you when the procedure is explained, to help you to remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.

People often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the lumbar puncture is likely to affect you and the staff should be willing to make time for you to ask questions.

The lumbar puncture

Before the lumbar puncture is done, you may have your blood pressure and pulse checked. As you will need to lie flat for some time following the procedure, remember to go to the toilet beforehand.

While the lumbar puncture is being done, you will need either to lie on one side with your knees drawn up towards your chest, or to sit up, bent over a table and supported by pillows. This positioning allows your back to curve as much as possible so that the bones of the spine (vertebrae) are widely separated.

The area of skin over the lower spine is cleaned with an antiseptic solution. Local anaesthetic is injected to numb the area. The doctor or nurse will wait for a few moments for the anaesthetic to take effect.

A hollow needle is inserted between two of the spinal bones and into the spinal canal. You will need to stay as still as possible at this time. You may feel a sensation of pressure as the needle is put in. Samples of CSF may then be withdrawn and/or chemotherapy drugs may be inserted.

Lumbar puncture

If chemotherapy drugs are being given, the doctor and nurses will do a number of safety checks, to ensure you are given only the medicines that have been prescribed for you. If you would like to, you can also check the drugs before they are given.

After the lumbar puncture has been completed, the needle is removed and a small dressing is put on. The entire procedure normally takes around 20 minutes, although this can vary depending on the reasons for why it is being done.

After the lumbar puncture

Lumbar puncture is not usually painful, although some people may find it uncomfortable. Some people may have a headache for a few hours afterwards. You will need to lie flat for a while after the procedure – from one hour to several hours, depending on how you feel. You will be able to roll from side to side, but sitting up can make the headache worse.

Let the doctor or nurse know if you have a headache, as mild painkillers can be given to help. You will also have your blood pressure and pulse checked again during this time. Ask the doctor or nurse when it will be safe for you to sit up. Once you have rested and feel well, you can safely return to your normal activities, although it is best not to drive or operate machinery for 24 hours after a lumbar puncture.

Sometimes a lumbar puncture is done more than once. Often, several doses (cycles) of chemotherapy are needed and a lumbar puncture will be done during every cycle until all of the planned treatment is completed.

Implantable ports

2007-06-19T22:04:00.000-07:00

This information is about implantable ports (sometimes called portacaths or subcutaneous ports). Implantable ports are often used to give chemotherapy treatment and/or other medicines to people who have cancer or leukaemia.

Implantable ports
What they are used for
How the port is put in
How it is used
Care of your implantable port
Possible problems
How the port is removed
Other information

Implantable ports

An implantable port is a thin, soft, plastic tube that is put into a vein in your chest or arm and has an opening (port) just under the skin. This allows medicines to be given into the vein or blood to be taken from the vein.

The tube is long, thin, hollow and known as a catheter. The port is a disc about 2.5–4cm in diameter. The catheter is usually inserted (tunnelled) under the skin of your chest. The tip of the catheter lies in a large vein just above your heart and the other end connects with the port which sits under the skin on your upper chest. The port will show as a small bump underneath your skin which can be felt, but nothing is visible on the outside of your body.

What they are used for

A port can be used to give you treatments such as chemotherapy, blood transfusions, high-calorie liquids or antibiotics. Ports can also be used when it is necessary to take samples of your blood for testing. This makes it possible for you to have your treatment without having to have needles frequently put into your veins.

You can go home with the port in and it can be left in place for weeks, months or, for some people, years. A port may be very useful if doctors or nurses find it difficult to get needles into your veins, or if the walls of your veins have been hardened by previous treatment. A port is more discreet than a central line or PICC line because it lies completely under the skin and has no external parts.

How the port is put in

Your port will be put in at the hospital by a surgeon or a radiologist. It is usually done in the operating theatre or an area called the vascular radiology unit. It can be put in either under a general anaesthetic or a local anaesthetic.

Before your surgery you may find it helpful to discuss the position of the port on your chest with the surgeon.

You will have a small needle put into a vein in your arm or hand and you will be given medicine to help you to relax. The doctor will inject a local anaesthetic into your skin to numb a couple of small areas on your chest and neck. After this you may be aware of activity around you and may feel some pressure on your chest (or arm) during the procedure, but you should not feel any pain.

You will have one or two small incisions (wounds). If the port is put into your chest vein the wound on your upper chest will be about 3–4 cm long and is where the port is placed. There may be a smaller incision on your neck which is usually less than 1–2 cm long. The catheter will be put into a vein in your chest and then tunnelled under the skin from the chest incision to the neck incision. The catheter is then attached to the port, which is fitted into a space created under the skin. The wounds are then stitched. If the stitches are not dissolvable they will be removed after about 7–10 days, when the wound has healed.

If the port is put into a vein in your arm the wound will be on the inner side of your arm.

You may also have a chest x-ray to make sure the port is in the right place.

A small dressing may be used to cover the wounds for a day or so after the procedure. The dressing may then be replaced, or the wound may be left exposed to the air.

You may feel a bit sore and bruised for a few days after the port is put in. A mild painkiller such as paracetamol will help with this.

Immediately after the port has been put in, and for a few days afterwards, check for any redness, swelling, bleeding, bruising, pain or heat around the wounds. Let your hospital doctor know straight away if you have any of these signs as you could have an infection, which may need to be treated.

How it is used

The port can be used soon after it has been put in, if necessary. When you are about to have treatment or have a blood sample taken, the skin over the port will be numbed with an anaesthetic cream which will be put on about half an hour beforehand. The skin will then be cleaned.

A special needle, known as a Huber needle, is used to push through the skin and into the port (see diagram, below).

This should not be painful but you may feel a pushing sensation.

The Huber needle connects with the catheter, allowing treatment to be given directly into the bloodstream. Blood samples can also be taken in this way if needed. If you are having a short treatment, the needle will then be withdrawn. For longer treatments, a dressing will be taped over the needle to hold it in place until the end of the treatment, when it will be removed.

Care of your implantable port

After each treatment a small amount of fluid is ‘flushed’ into the catheter so that it does not become blocked. The port will need to be flushed every four weeks if it is not being used regularly. The nurses at the hospital may teach you (or a friend or relative) to do this for yourself if you feel able to, or a district nurse can do it for you at home. Apart from this, your port will not need any care at all.

Possible problems

Infection

It is possible for an infection to develop either inside the catheter or around the port. You should tell your hospital if:

the area around the port becomes red, swollen or painful
you develop a temperature, feel faint, shivery, breathless or dizzy.

You will be given antibiotics, but occasionally, if the infection is serious, the port may have to be removed.

Clots

It is possible for a clot to form in the line in which the catheter sits. If this happens, the port may have to be removed. You will also be given some medication to dissolve the clot. Signs of a clot include swelling in the neck or in the arm (depending on where exactly the catheter is).

How the port is removed

When you no longer need the implantable port it will be taken out. This is usually done by a doctor who will use a local anaesthetic to numb the area. Sometimes the port will be removed under a general anaesthetic.

The doctor will make a small incision over the site of the port and remove it. The catheter will be pulled out of the vein. The wound is then stitched and covered with a small dressing.

You may feel a bit sore and bruised after your port is removed. A mild painkiller such as paracetamol will help with this.

Other information

The port should not interfere with your daily activities, although it is advisable to avoid strenuous exercise for a few weeks after surgery, so that your body can heal. Your doctor or nurse can give you information about this. Do not constrict or compress your port by sleeping on it or wearing tight clothing over it.

If the port is in your arm, do not let anyone take your blood pressure, or take blood from a vein in that arm. Do not lift anything heavier than 15lb (7kg).

Only the Huber needles should be used on your port. Do not let anyone use any other type of needle on your port.

You may wish to wear a medical ID bracelet saying that you have an implanted port.

PICC lines (peripherally inserted central catheters)

2007-06-19T20:27:00.000-07:00

PICC lines
What they are used for
How the line is put in
Possible problems when putting in the PICC
Care of your PICC line
Possible problems
How the PICC line is removed

PICC lines

A PICC is a long, thin, flexible tube known as a catheter. It is inserted into one of the large veins of the arm near the bend of the elbow. It is then slid into the vein until the tip sits in a large vein just above the heart.

The space in the middle of the tube is called the lumen. Sometimes the tube has two or three lumens (known as double or triple lumen). This allows different treatments to be given at the same time. At the end of the tube outside the body, each lumen has a special cap to which a drip line or syringe can be attached. There is also a clamp to keep the tube closed when it is not in use.

The tube is threaded through the vein until the end is near to your heart.

What they are used for

The PICC line can be used to give you treatments such as chemotherapy, antibiotics and intravenous fluids and feeding. It can also be used to take samples of your blood for testing. You can go home with the PICC in and it can be left in for weeks or months. This makes it possible for you to have your treatment without having to have needles frequently inserted into your veins. This may be particularly helpful if your veins are hard to find or have been hardened by previous chemotherapy treatment.

The end of the tube comes out just below the bend of your elbow

How the line is put in

Your PICC will be put in by a specially trained nurse or doctor, in an outpatient department or on the ward. It will be put in using a local anaesthetic, so that you do not feel any pain.

First, the skin in the area where the PICC will be inserted is numbed, using a special anaesthetic cream. When the skin is completely numb a needle will be inserted and then removed as the PICC is threaded through it into the large vein which leads to your heart. This should not take long and is usually painless. The PICC will be held securely in place by a transparent dressing. You will then have a chest x-ray to check that the end of the tube is in the correct position.

Possible problems when putting in the PICC

If your veins are small, it may be difficult to put the PICC in. Sometimes it can be difficult to thread the PICC up the vein towards the heart. If this happens, it is possible to try again using a different vein.

Sometimes the PICC seems to go in easily but the x-ray shows it is not in the right place. If this happens it will be taken out and replaced.

Care of your PICC line

When the line is not being used there is a slight risk that it may become blocked. To stop this happening a small amount of fluid is flushed into the line using a syringe. This is done regularly, usually once a week. The dressing will also need to be changed each week to reduce the risk of infection.

As it is difficult to do this yourself with one hand, the nurses at the hospital may do it for you or arrange for a district nurse to visit you at home. A partner, relative or friend can also be taught to do this if they feel happy to.

Possible problems

Infection

It is possible for an infection to develop inside or around the place where the line goes into the vein. If this area becomes red, swollen or oozes, or if you develop a temperature, you should tell your hospital doctor or nurse. You will be given antibiotics or, occasionally, the line may have to be removed.

Clots

It is possible for a blood clot (thrombosis) to form in your vein at the tip of the PICC. You may be given a tablet of warfarin (an anticoagulant) to take each day to help prevent this. If you do develop a blood clot the line may have to be removed. You will then be given medicines to dissolve the clot.

Air in the line

Air must not be allowed to get into your PICC line. The clamps should always be closed when the line is not in use. The line must not be left unclamped when the caps are not in place.

Break or cut in the PICC

It is important that the PICC line is not cut or split. Do not use scissors near the PICC. If it does get damaged you should contact your hospital immediately as it may need to be removed if it cannot be repaired while still in place.

How the PICC line is removed

When you no longer need a PICC it will be taken out. A nurse will usually do this for you in an outpatient department. It will be gently pulled out. This is a painless procedure that takes only a few minutes.

Central lines (Skin-tunnelled venous catheters)

2007-06-19T20:08:00.000-07:00

Central lines

A central line is a long, hollow tube made from silicone rubber. They are also called skin-tunnelled central venous catheters. Examples of some of the makes that are used are Hickman® or Groshong®. The central line is inserted (tunnelled) under the skin of your chest into a vein. The tip of the tube sits in a large vein just above your heart.

The space in the middle of the tube is called the lumen. Sometimes the tube has two or three lumens. At the end of the tube outside the body each lumen has a special cap to which a drip line or syringe can be attached. Sometimes there is also a clamp to keep the tube closed when it is not being used.

What they are used for

A central line can be used to give you treatments such as chemotherapy, antibiotics and intravenous fluids. It can also be used to take samples of your blood for testing. Central lines can also be used to give liquid food into the vein if your digestive system is not able to cope with food for any reason.

You can go home with the central line in and it can be left in for weeks or months. This makes it possible for you to have your treatment without having to have needles frequently put into your veins. This may be very helpful if doctors and nurses find it difficult to get needles into your veins, or if the walls of your veins have been hardened by previous chemotherapy treatment.

How a central line is put in

Your central line will be put in at the hospital by a doctor or specially-trained nurse. It is usually put in under a local anaesthetic, but sometimes a general anaesthetic is used. You should not feel any pain when the tube is being put in, but you may feel a bit sore for a few days afterwards.

First, your chest is cleaned with an antiseptic solution. A small cut is made in the skin near your collarbone and the tip of the tube is threaded into a large vein. This is called the insertion site. The tube is then tunnelled under the skin to reach the exit site. The exit site is the place where the end of the tube comes out of your body (see diagram). You will have a chest x-ray to make sure that the tube is in the right place.

The position of the exit site will vary from person to person. You can ask the person who is going to put the central line in where the exit site is likely to be on your chest.

When the tube has been put in you will have dressings covering the insertion and exit sites. For a few days you may have some pain or discomfort where the tube has been tunnelled under the skin. A mild painkiller such as paracetamol will help to ease this.

Position of a central line

What stops the central line falling out?

There is a small 'cuff' around the central line which can be felt under the skin just above the exit site. The tissue under the skin grows around this cuff over a period of about three weeks and holds the line safely in place. Until this has happened you will have a stitch holding the line in place.

Care of your central line

When the central line is not being used there is a small risk that it may become blocked. To stop this happening a small amount of fluid is 'flushed' into the line using a syringe. This is usually done once a week. The exit site will also need to be cleaned once a week to reduce the risk of infection. If you have a dressing on the site it will need to be changed once a week.

The nurses at the hospital may teach you how to do this for yourself if you feel able to, or a district nurse can do it for you at home.

Possible problems

Infection

It is possible for an infection to develop either inside the central line or around the exit site. You should contact your hospital doctor or nurse if:

the exit site becomes red or swollen or painful
you notice discoloured fluid coming from it
you develop a temperature.

You will be given antibiotics but if these do not clear the infection from the line, it may have to be removed.

Clots

It is possible for a blood clot (thrombosis) to form in your vein at the tip of the line. You may be given a tablet of warfarin (an anticoagulant) to take each day to help prevent this. If a clot does form the line may have to be removed. You will also be given some medication to dissolve the clot.

Signs of this are:

Air in the central line No air must be allowed to get into your central line. The clamps should always be closed when the line is not in use. The line must not be left unclamped when the caps are not in place.

Break or cut in the line It is important that you do not get a break or cut in the line. Do not use scissors near the line and only use the clamp on the thicker, strengthened part of the line.

If the line does get cut or split, try to clamp it between the split and the exit site (where it comes out of your body) and call your hospital. The nurses may be able to repair the line, but if this can't be done, the line will be removed.

How the central line is removed

When you no longer need the central line it will be taken out. A doctor or nurse will do this for you, usually in the outpatients department. You will not need to have a general anaesthetic when the central line (catheter) is removed.

You will be asked to lie flat on a bed. Your chest will be cleaned with antiseptic, and the line will be gently but firmly pulled until it loosens and comes free. This does not usually take more than a few minutes, but can be uncomfortable.

If the line has been there a long time, the nurse or doctor may need to do a minor procedure to remove it.

A dressing will be put over the exit site and you will be asked to remain lying down until it is certain that there is no bleeding.

Combination chemotherapy regimen

2007-06-18T22:39:00.000-07:00

This section contains information about combination chemotherapy regimen. It includes information about how each regimen is given and possible side effects that may be experienced with that regimen.

A chemotherapy drug can be either given on its own or in combination with other drugs. This is when more than one chemotherapy drug is given. If you cannot find information about a particular regimen there is further information about chemotherapy in the individual chemotherapy drug section.

The list of regimen is in alphabetical order, select the one you are interested in for further information.

ABVD
AC
BEP
C-VAMP
CAF
Capecitabine & docetaxel
Carboplatin & etoposide
CAV
ChlVPP
Cisplatin & fluorouracil
CMF
de Gramont
DHAP & R-DHAP
Docetaxel & cisplatin
Doxorubicin & ifosfamide
E-CMF
EC
ECF
ECX
EEX
ELF
ESHAP & R-ESHAP
Etoposide & cisplatin
FEC
GemCap
GemCarbo
Gemcitabine & cisplatin
GemTaxol
ICE & RICE
Irinotecan with de Gramont
Mayo
MIC
MM
MMM
MVP
Oxaliplatin & 5FU
Paclitaxel & carboplatin
Pemetrexed & cisplatin
PCV
PMitCEBO
R-CHOP & CHOP
TAC
VAD
VAPEC-B
Vinorelbine & carboplatin
Vinorelbine & cisplatin

Vinorelbine (Navelbine®)

2007-06-18T22:38:00.001-07:00

Vinorelbine (pronounced vi-nor-el-been) is a chemotherapy drug that is given as a treatment for some types of cancer including breast cancer and non-small-cell lung cancer. This information describes vinorelbine, how it is given and some of its possible side effects. It will help you to read it with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What vinorelbine looks like
How it is given
Possible side effects
Less common side effects
Additional information
Things to remember about vinorelbine capsules

What vinorelbine looks like

Vinorelbine is a colourless fluid. It is also available as 20mg and 30mg capsules.

How it is given

Vinorelbine may be given:

by injection into a vein (intravenously) through a fine tube (cannula) inserted into the vein
through a central line, which is inserted under the skin into a vein near the collarbone, or through a PICC line, which is inserted into a vein in the crook of the arm.
as capsules, swallowed whole with a glass of water. You should take the capsules exactly as you have been directed. Your doctor or chemotherapy nurse will explain when the capsules should be taken.

Possible side effects

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others experience more. The side effects described in this information will not affect everyone who is given vinorelbine, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common and less common effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Vinorelbine can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Vinorelbine can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with vinorelbine you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Constipation This can usually be relieved by drinking plenty of fluids, eating a high fibre diet and taking gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. These can be prescribed by your doctor.

Diarrhoea This can usually be easily controlled with medicine, but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea. If you have any change in bowel habit tell your doctor.

Feeling sick (nausea) or being sick This is usually mild. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor, who can prescribe other anti-sickness drugs that may be more effective.

Numbness or tingling in hands or feet This is due to the effect of vinorelbine on the nerves and is known as peripheral neuropathy. Most people do not have this effect and if it occurs it is usually mild. You may also notice that you have difficulty doing up buttons or other fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. This effect usually improves slowly from a few months after the treatment is finished.

Pain along the vein used for the injection Vinorelbine can cause irritation at the site used for the injection. If this happens, it is important to tell the person giving the drug, as they can reduce the problem by flushing the drug through with more fluid.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Less common side effects

Hair loss This is rare, but hair may thin, or occasionally be lost completely. If this happens it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. Hair loss is temporary and your hair will regrow once the treatment is finished.

Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness of the face, a dry mouth, headache, breathlessness, anxiety and a need to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these signs.

Leaking around the vein If vinorelbine leaks into the tissues around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell the doctor or nurse. If the area around the cannula site becomes red or swollen at any time you should tell either the doctor or nurse on the ward.

Additional information

Other medicines Some medicines may be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. You may want to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking vinorelbine, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Things to remember about vinorelbine capsules

It is important to take your capsules at the right times. You must take them as directed by your doctor.
If you are given capsules to take home, you should keep them in a safe place in the fridge and where children cannot reach them, as vinorelbine could harm them.
If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist at your next visit. Do not flush them down the toilet or throw them away.
If you are sick just after taking the capsules let your nurse or doctor know straight away. Do not take more capsules unless told to by your nurse or doctor.

Vindesine (Eldisine®)

2007-06-18T22:37:00.001-07:00

Vindesine (pronounced vin-de-seen) is a chemotherapy drug that is given as a treatment for some types of cancer including leukaemia, lymphoma, melanoma, breast, and lung cancer. This information describes vindesine, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What vindesine looks like
How it is given
Possible side effects
Less common side effects
Additional information

What vindesine looks like

Vindesine is a colourless fluid after being dissolved from powder.

How it is given

Vindesine may be given:

by injection into a vein (intravenously) through a fine tube (cannula) inserted into the vein
through a central line, which is inserted under the skin into a vein near the collarbone, or through a PICC line, which is inserted into a vein in the crook of the arm.

Possible side effects

We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss these with your doctor or chemotherapy nurse.

Lowered resistance to infection Vindesine can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Vindesine can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with vindesine you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Hair loss This usually starts 3-4 weeks after the first dose of vindesine, although it may occur earlier. Hair may be lost completely, but it is more usual for it to just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will return to normal once the treatment is finished.

Abdominal cramps and constipation These can usually be relieved by drinking plenty of fluids, eating a high fibre diet and taking gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. These can be prescribed by your doctor.

Numbness or tingling in hands or feet This is due to the effect of vindesine on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. This usually improves slowly a few months after the treatment is finished. Very rarely, other nerves may be affected (eg neck nerves) which may cause jaw pain or double vision.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Less common side effects

Skin changes Vindesine can cause a rash which may be itchy. Your doctor can prescribe medicine to help with this.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Diarrhoea This can usually be easily controlled with medicine but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Nausea (feeling sick) and vomiting This is usually very mild and there are now very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If you do feel sick it may begin soon after the treatment is given and can last for up to a day. If the sickness is not controlled or continues tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.

Additional information

If vindesine leaks into the tissue around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site tell the doctor or nurse immediately.

If the area around the injection site becomes red or swollen at any time tell the doctor or nurse on the ward, or if you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.

Other medicines Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking vindesine, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Vincristine (Oncovin®)

2007-06-18T22:36:00.000-07:00

Vincristine (pronounced vin-chris-teen) is a chemotherapy drug that is given as a treatment for some types of cancer including leukaemia, lymphoma, breast and lung cancer. This information describes vincristine, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What vincristine looks like
How it is given
Possible side effects
Less common side effects
Additional information

What vincristine looks like

Vincristine is a colourless fluid after being dissolved from powder.

How it is given

Vincristine may be given:

by injection into a vein (intravenously) through a fine tube (cannula) inserted into the vein
through a central line, which is inserted into a vein near the collarbone, or through a PICC line, which is inserted into a vein in the crook of the arm.

Possible side effects

We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Abdominal cramps and constipation It usually helps to drink plenty of fluids, eat a high fibre diet and take gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. These can be prescribed by your doctor.

Numbness or tingling in hands or feet This is due to the effect of vincristine on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. This usually improves slowly a few months after the treatment is finished. Very rarely other nerves may be affected (such as the neck nerves) which may cause pain in the jaw or double vision.

Less common side effects

Hair loss Hair may thin, or may occasionally be lost completely. If this happens it usually begins about three to four weeks after starting treatment, although it may occur earlier. Hair loss is temporary and your hair will regrow once the treatment is finished.

Temporary taste changes A dietitian or specialist nurse at your hospital can give advice.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Lowered resistance to infection Vincristine can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

Bruising or bleeding Vincristine can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with vincristine you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Additional information

If vincristine leaks into the tissue around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site it is very important that you tell the doctor or nurse.

If the area around the injection site becomes red or swollen at any time you should either tell the doctor or nurse on the ward, or if you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. Discuss this with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking vincristine, as vincristine may harm the developing foetus. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Vinblastine (Velbe®)

2007-06-18T22:35:00.000-07:00

Vinblastine (pronounced vin-blas-teen) is a chemotherapy drug that is given as a treatment for some types of cancer including leukaemia, lymphoma, breast and lung cancer. This information describes vinblastine, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What vinblastine looks like
How it is given
Possible side effects
Less common side effects
Additional information

What vinblastine looks like

Vinblastine is a colourless fluid after being dissolved from powder.

How it is given

Vinblastine may be given:

by injection into a vein (intravenously) through a fine tube (cannula) inserted into the vein
through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line, which is inserted into a vein in the crook of the arm.

Possible side effects

We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Vinblastine can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

Bruising or bleeding Vinblastine can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with vinblastine you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Nausea (feeling sick) and vomiting This is usually mild if it occurs at all. If you do feel sick it may begin after the treatment is given and last for up to a day. Your doctor can now prescribe effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If it is not controlled or continues, tell your doctor, who can prescribe other drugs that may be more effective.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Less common side effects

Hair loss It is very unusual to lose your hair. Some people notice that their hair becomes a little thinner, but not usually enough to be noticeable to other people.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you do have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Diarrhoea This can usually be easily controlled with medicine but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Numbness or tingling in hands or feet This is caused by the effect of vinblastine on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or other fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet.

Peripheral neuropathy usually improves slowly a few months after the treatment is finished. Very rarely other nerves may be affected (eg neck nerves) which may cause pain in the jaw or double vision.

Headaches Let your doctor know if you have headaches while having treatment with vinblastine. Medicines can be prescribed to help.

Additional information

If vinblastine leaks into the tissue around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site it is very important that you tell your doctor or nurse.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking vinblastine, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Treosulfan

2007-06-18T22:34:00.001-07:00

Treosulfan (pronounced tree-o-sul-fan) is a chemotherapy drug that is given as a treatment for some types of cancer. It is most commonly used to treat ovarian cancer. This information describes treosulfan, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What treosulfan looks like
How it is given
Possible side effects
Less common side effects
Additional information
Things to remember about treosulfan capsule

What treosulfan looks like

Treosulfan is available as white capsules of 250mg.
It is also available as a colourless fluid, after being dissolved from powder.

How it is given

Treosulfan may be given:

as capsules (orally). The capsules should be swallowed whole with plenty of water
as a drip (infusion) through a fine tube (cannula) inserted into the vein. It may also be given through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line, which is inserted into a vein in the crook of the arm
by injection into a vein (intravenously) through a cannula
by injection into the abdominal cavity (intraperitoneally)

Possible side effects

We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Treosulfan can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

Bruising or bleeding Treosulfan can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with treosulfan you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Skin changes Treosulfan can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Your skin may darken due to excess production of pigment. This usually returns to normal a few months after the treatment has finished.

Tiredness and feeling weak It is important to allow yourself plenty of time to rest.

Less common side effects

Nausea (feeling sick) and vomiting If you do feel sick it may begin soon after the treatment is given and can last for about a day. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled or continues tell your doctor, who can prescribe other anti-sickness drugs that may be more effective.

Hair loss It is very unusual to lose your hair. Some people notice that their hair becomes a little thinner, but not usually enough to be noticeable to other people.

Irritation of the bladder It is important to drink plenty of fluids for up to 24 hours after your chemotherapy to help prevent any irritation.

Additional information

If treosulfan leaks into the tissue around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell the doctor or nurse immediately.

Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking treosulfan, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Things to remember about treosulfan capsules

Store the capsules in the original packaging, at room temperature away from direct sunlight.
It is important to take your capsules at the right times. You must take them as directed by your doctor
Keep the capsules in a safe place where children cannot reach them, as treosulfan could harm them
If your doctor decides to stop the treatment, return any remaining capsules to the pharmacist. Do not flush them down the toilet or throw them away
If you are sick just after taking the capsule let your doctor know, as you may need to take another one. Do not take another capsule without first informing your doctor
If you forget to take a capsule do not take a double dose. Let your doctor know and keep to your regular dose schedule.

Topotecan (Hycamtin®)

2007-06-18T22:31:00.000-07:00

Topotecan (pronounced top-o-tee-can) is a chemotherapy drug that is given as a treatment for some types of cancer. It is mainly used to treat ovarian cancer or small-cell lung cancer (SCLC). This information describes topotecan, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What topotecan looks like
How it is given
Possible side effects
Less common side effects
Additional information

What topotecan looks like

Topotecan is a colourless fluid after being dissolved from powdered form.

How it is given

Topotecan may be given:

as a drip (infusion) into a vein (intravenously) through a fine tube (cannula) placed into the vein
through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line, which is inserted into a vein in the crook of the arm.

Possible side effects

We have outlined the most common side effects and those that are less common, so that you can be aware of them if they occur. However, we have not included those which are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Topotecan can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point around nine days after chemotherapy. Your blood cells will then increase steadily over the next seven days, and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

Bruising or bleeding Topotecan can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with topotecan you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Feeling sick (nausea) or being sick If you do feel sick it may begin a few hours after the treatment is given and can last for up to a day. This is usually mild and your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.

Loss of appetite This is also usually mild and may last a day or so. A dietitian or specialist nurse at your hospital can give you advice about boosting your appetite, coping with eating difficulties and maintaining weight. The dietitian at the hospital can be very helpful.

Hair loss This usually starts 3–4 weeks after the first dose of topotecan. Hair may be lost completely or may just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will regrow once the treatment is finished.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Less common side effects

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Diarrhoea This can usually be easily controlled with medicine, but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Additional information

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. You may want to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking topotecan, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Tioguanine (Lanvis®)

2007-06-18T22:30:00.000-07:00

Tioguanine (sometimes spelt thioguanine and pronounced thigh-o-gwah-neen) is a chemotherapy drug that is given as a treatment for some types of cancer. It is most usually used to treat leukaemia. This information describes tioguanine, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of leukaemia or cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What tioguanine looks like
How it is given
Possible side effects
Less common side effects
Additional information
Things to remember about tioguanine tablets

What tioguanine looks like

Tioguanine is available as 40mg yellow tablets.

How it is given

The tablets should be swallowed whole with plenty of water on an empty stomach.

Possible side effects

We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Tioguanine can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

Bruising or bleeding Tioguanine can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with tioguanine you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are a problem.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Your liver may be temporarily affected Tioguanine may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. This is unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver is working properly.

Less common side effects

Nausea (feeling sick) and vomiting This is unusual, but if you do feel sick it may begin soon after the treatment is given and can last for a few days. If this occurs, your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If it is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs that may be more effective.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you do have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Diarrhoea This can usually be easily controlled with medicine, but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Additional information

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking tioguanine, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Things to remember about tioguanine tablets

Store the tablets in their original packaging, at room temperature in a dry place away from direct sunlight.
It is important to take your tablets at the right times. You must take them as directed by your doctor
Keep the tablets in a safe place where children cannot reach them, as tioguanine could harm them
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away
If you forget to take a tablet do not take a double dose. Let the doctor know and keep to your regular dose schedule
If you are sick just after taking the tablet let your doctor know as you may need to take another one. Do not take another tablet without first telling your doctor.

Thiotepa

2007-06-18T22:29:00.000-07:00

Thiotepa (pronounced thigh-o-tee-pa) is a chemotherapy drug that is given as a treatment for some types of cancer. This information describes thiotepa, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy

and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What thiotepa looks like
How it is given
Possible side effects
Less common side effects
Additional information

What thiotepa looks like

Thiotepa is a colourless fluid after being dissolved from powder.

How it is given

Thiotepa may be given:

by injection into a muscle (intramuscularly)
as a drip (infusion) through a fine tube (cannula) inserted into the vein. It may be given through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line, which is inserted into a vein in the crook of the arm.
as an injection into the vein (intravenously) through a cannula
directly into the bladder (intravesically)
by injection into the muscle (intramuscularly)
by injection into the fluid around the spinal cord through a lumbar puncture (intrathecally) or an Ommaya reservoir (a flat plastic bubble which has been inserted into an area beneath the scalp). Only specially trained doctors and nurses can give drugs in this way and the procedure has to be carried out in a special area, so you may be given this treatment by different staff and in a different hospital from the rest of your chemotherapy.

Possible side effects

We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Thiotepa can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given and your resistance to infection usually reaches its lowest point any time up to 30 days after the chemotherapy. Your blood cells will then gradually return to normal over 21–28 days.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

Bruising or bleeding Thiotepa can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with thiotepa you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Nausea (feeling sick) and vomiting If you do feel sick it may begin several hours after the treatment is given and may continue while you are having your treatment. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs that may be more effective.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Less common side effects

Skin changes Your skin may darken due to excess production of pigment. This usually returns to normal a few months after the treatment has finished.

Hair loss This is rare, but hair may thin or occasionally be lost completely. If this happens it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. Hair loss is temporary, and your hair will regrow once the treatment is finished.

Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, a headache, breathlessness, anxiety and a need to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these signs.

Long-term changes in the way your bone marrow works Long-term thiotepa treatment may permanently damage the bone marrow. This can affect the production of healthy blood cells and may lead to the development of myelodysplasia (a condition affecting the function of the bone marrow) or leukaemia (cancer of the white blood cells). The risks of long-term damage are outweighed by the benefits of the drug. Your doctor can discuss this with you further.

Additional information

The side effects mentioned above are most likely to occur if thiotepa is given into a vein (intravenously). The other ways of giving thiotepa are less likely to cause side effects.

If thiotepa is given into the bladder, it may irritate the bladder lining. This may mean that you want to pass urine more often (cystitis). Your doctor can prescribe medicine to reduce this feeling. Other side effects are very rare when thiotepa is given in this way.

If thiotepa is given into the fluid around the spinal cord it can temporarily cause dizziness and headaches.

Thiotepa eye drops may be used to treat a non-cancerous condition of the eye. The eye drops may cause some irritation of the skin around the eye. There may also be loss of colour in the skin in this area. Other side effects do not occur.

While thiotepa is being given intravenously it can cause pain at the place where the injection is given, or along the vein. If you feel pain, tell your doctor or nurse.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking thiotepa, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Teniposide (Vumon®, VM-26®)

2007-06-18T22:28:00.000-07:00

Teniposide (pronounced ten-ip-o-side) is a chemotherapy drug that is given as a treatment for some types of cancer. It can be used on its own or in combination with other chemotherapy drugs to treat adult and childhood leukaemias, types of lymphoma, Hodgkin lymphoma and childhood neuroblastoma. It may also be used for some other types of cancer. Although teniposide has been in use for many years, it is currently not licensed for use in the UK. However, the drug may be given to individual patients who have been selected by their doctor as suitable (this is called named-patient prescribing).

This information describes teniposide, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What it looks like
How it is given
Possible side effects
Less common side effects
Additional information

What it looks like

Teniposide is a colourless fluid.

How it is given

Teniposide is given by injection:

into a vein (intravenously) through a fine tube (cannula) placed into the vein
through a fine plastic tube which is inserted under the skin into a vein near the collarbone (central line) or passed through a vein in the arm (PICC line).

Possible side effects

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given teniposide, and may be different if you are having more than one chemotherapy drug. We have outlined the most common side effects and those which are less common, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Nausea (feeling sick) and vomiting If this occurs it may begin a few hours after the treatment is given and last for up to a day. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs that may be more effective.

Lowered resistance to infection Teniposide can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally, it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Teniposide can reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with teniposide you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Diarrhoea This can usually be easily controlled with medicine but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after treatment.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Less common side effects

Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness of the face, dizziness, headache, breathlessness and anxiety. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these signs.

Hair loss If this happens it usually starts two to three weeks after the first dose of teniposide, although it may occur earlier. Your hair is most likely to just thin but could be lost completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and all your hair will regrow once the treatment ends.

Low blood pressure This may sometimes be experienced whilst the drug is given. Let your doctor know if you feel faint or dizzy.

Additional information

While teniposide is being given, it can cause pain at the place where the injection is given, or along the vein. If you feel pain tell the doctor or nurse and they can slow the drip down.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking teniposide as it may harm the developing foetus. It is important to use effective contraception whilst taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Temozolomide (Temodal®)

2007-06-18T22:27:00.000-07:00

Temozolomide (pronounced tee-mo-zol-o-mide) is a chemotherapy drug that is given as a treatment for some types of cancer. It is most commonly used to treat a type of brain tumour known as a glioma. This information describes temozolomide, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What temozolomide looks like
How it is given
Possible side effects
Less common side effects
Additional information
Things to remember about temozolomide capsules

What temozolomide looks like

Temozolomide is available as 5mg, 20mg, 100mg and 250mg capsules.

How it is given

The capsules should be swallowed whole with plenty of water and be taken at the same time every day on an empty stomach. It is important to make sure that you take the capsules exactly as you have been directed by your doctor.

Possible side effects

We have outlined the most common side effects and those that are less common, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Temozolomide can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels within 21–28 days.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

Temozolomide is sometimes given at the same time as a six week course of radiotherapy. Your blood cell count will be monitored throughout the course of treatment to make sure that the number of white blood cells doesn't get too low.

Bruising or bleeding Temozolomide can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with temozolomide you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Nausea (feeling sick) and vomiting If you do feel sick it may begin soon after the treatment is given and may last for approximately 24 hours. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs that may be more effective.

Diarrhoea This can usually be easily controlled with medicine but it is important to let your doctor know if it is severe or continues. It is important to drink plenty of fluids if you have diarrhoea.

Constipation Constipation can usually be relieved by drinking plenty of fluids, eating a high fibre diet and taking gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. These can be prescribed by your doctor.

Loss of appetite and temporary taste alterations Both of these may occur. A dietitian or specialist nurse at your hospital can give advice on boosting appetite, coping with eating difficulties and maintaining weight.

Rashes Temozolomide can cause a rash which may be itchy. Your doctor can prescribe treatment to help reduce this.

Headache Let your doctor know if you have headaches while having treatment with temozolomide.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Less common side effects

Hair loss This is rare but hair may thin, or occasionally be lost completely. If hair loss happens, it usually begins 3–4 weeks after starting treatment, although it may occur earlier. It is temporary and your hair will regrow once the treatment is finished. If you are having temozolomide with a course of radiotherapy any hair loss will be due to the radiotherapy and may be permanent.

Dizziness This side effect should be reported to your doctor.

Breathlessness Let your doctor know if breathlessness occurs.

A high temperature and chills These usually do not last for long. Your doctor may prescribe tablets to reduce this side effect.

Additional information

Drowsiness Temozolomide may make you drowsy. Take care if you are driving or operating machinery following this treatment.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. You may wish to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking temozolomide, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Things to remember about temozolomide capsules

It is important to take your capsules at the right times. You must take them as directed by your doctor.
Keep the tablets in the original packaging and store them at room temperature, away from heat and direct sunlight.
Keep the capsules in a safe place where children cannot reach them, as temozolomide could harm them.
If your doctor decides to stop treatment, return any remaining capsules to the pharmacist. Do not flush them down the toilet or throw them away.
If you are sick just after taking the capsules let your doctor know as you may need to take another one. Do not take another capsule without first telling your doctor.
If you do forget to take a capsule do not take a double dose. Tell your doctor and keep to a regular dose schedule.

Tegafur-uracil (Uftoral®)

2007-06-18T22:25:00.000-07:00

Tegafur-uracil (pronounced teg-a-fur you-ra-sill) is a chemotherapy drug that is given as a treatment for some types of cancer, especially bowel cancer. It is also sometimes called UFT. This information describes tegafur-uracil, how it is given and some of the possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

How tegafur-uracil is given
How it works
Possible side effects
Less common side effects
Additional information
Things to remember about taking tegafur-uracil capsules

How tegafur-uracil is given

Tegafur-uracil is taken as white capsules three times a day at regular intervals. It is usually taken for four weeks, followed by a seven day break. The cycle is then repeated.

A tablet called calcium folinate (folinic acid) is given with tegafur-uracil. This is thought to increase its effectiveness.

How it works

Tegafur-uracil is a combination of two chemotherapy drugs: tegafur and uracil. When the capsules are taken, the tegafur is taken up by the cancer cells and slowly develops into what is known as the active drug fluorouracil (5FU). However, within the cells is an enzyme that breaks down the 5FU. The uracil slows the breakdown of 5FU, which means that the 5FU stays in the cancer cells for longer. Combining these two drugs means there is also a higher concentration of 5FU in the tumour cells than when tegafur is given alone, or when the same dose of 5FU is given into a vein. 5FU itself has been used as a treatment for bowel cancer for almost 50 years.

Possible side effects

We have outlined the most common side effects and the less common effects so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

The known side effects of tegafur-uracil are not usually severe. The following are the most common:

Diarrhoea This can usually be easily controlled with medicines, but let your doctor know if it is severe or if it continues. If you have diarrhoea it is important to drink plenty of fluids to replace the fluid that you lose.

Nausea (feeling sick) and vomiting If this does happen, it may begin a few hours after you have taken the drug. This is usually mild and your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.

Fatigue (tiredness and a general feeling of weakness) You may feel very tired. It is important to allow yourself plenty of time to rest.

Lowered resistance to infection Tegafur-uracil can reduce the production of white blood cells by the bone marrow, making you more prone to infection. The extent to which your bone marrow is affected depends on the dose of chemotherapy you are given and whether you are being given other chemotherapy drugs at the same time. Your blood cells will usually have returned to normal before your next course of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

Bruising or bleeding Tegafur-uracil can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with tegafur-uracil you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Less common side effects

Hair loss This is rare but hair may thin, or occasionally be lost completely. if hair loss happens, it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. It is temporary and the hair will regrow once the treatment ends.

Changes to the nails Your nails may become brittle, chipped and ridged. These changes grow out slowly over a few months once treatment has ended.

Rashes and dry skin The treatment may cause a rash or dry skin, which may be itchy. Your doctor can prescribe treatment to help reduce this.

Watery and sore eyes Tegafur-uracil may make your eyes produce more tears than normal. You may also develop 'pink-eye' (conjunctivitis) which can be sore and itchy. Your doctor can prescribe treatment to sooth your eyes, or you can get eye drops from your pharmacist.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Temporary effect on liver function Tegafur-uracil may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. You are very unlikely to notice any problems but your doctor will take blood to check your liver is working properly before each dose of tegafur-uracil.

Additional information

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking tegafur-uracil, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Things to remember about taking tegafur-uracil capsules

It is important to take your capsules at the right times. You must take them as directed by your doctor.
Keep the tablets in the original packaging and store them at room temperature, away from heat and direct sunlight.
Keep the tablets in a safe place where children cannot reach them, as tegafur-uracil could harm them.
If your doctor decides to stop treatment return the remaining capsules to the pharmacist. Do not flush them down the toilet or throw them away.
If you are sick or forget to take your capsule do not take a double dose. Tell your doctor and keep to your regular dose schedule.
As far as possible, take tegafur-uracil on an empty stomach, i.e. one hour before or after meals.

Streptozocin (Zanosar®)

2007-06-18T22:24:00.000-07:00

Streptozocin (pronounced strep-toe-zo-sin) is a chemotherapy drug that is given as a treatment for some types of cancer. It is currently not licensed in the UK and is only available to a small number of people whose specialists think that it may help them. This is known as named-patient prescribing. This information describes streptozocin, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What streptozocin looks like
How it is given
Possible side effects
Less common side effects
Additional information

What streptozocin looks like

Streptozocin is a colourless fluid after being dissolved from powder.

How it is given

Streptozocin may be given:

as a drip (infusion) through a fine tube (cannula) inserted into the vein. It may also be given through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line, which is inserted into a vein in the crook of the arm
by injection into a vein (intravenously) through a cannula.

Possible side effects

We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Nausea (feeling sick) and vomiting If this does happen it may begin a few hours after the treatment is given, and can last for a few days. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.

Hair loss This usually starts 3–4 weeks after the first dose of streptozocin, although it may happen earlier. Hair may be lost completely, or may just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will regrow once the treatment is finished.

Your liver may be affected temporarily Streptozocin may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. This is very unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver is working properly.

Your kidneys may be affected Usually this does not cause any symptoms and the effect is usually mild, but if the effect is severe the kidneys can be permanently damaged unless treatment is stopped. For this reason your kidneys will be checked by a blood test before each treatment.

Less common side effects

Lowered resistance to infection Streptozocin can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

Bruising or bleeding Streptozocin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with streptozocin you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Diarrhoea This can usually be easily controlled with medicine but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

The levels of sugar in your blood may change Your blood-sugar levels will be checked by regular blood tests and you may be taught how to test your own levels at home. Some signs of a raised blood-sugar level are feelings of thirst, needing to pass urine more often and an increased appetite. Some signs of a low blood-sugar level are dizziness, confusion and sweating. Tell your doctor or nurse if you notice any of these.

Additional information

If streptozocin leaks into the tissue around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell the doctor or nurse immediately.

Other medicines Some medicines can be harmful when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking streptozocin, as the developing foetus may be harmed. It is necessary to use effective contraception while taking this drug and for at least a few months afterwards. Again, discuss this with your doctor.

Raltitrexed (Tomudex®)

2007-06-18T22:23:00.000-07:00

Raltitrexed (pronounced ral-ti-trex-ed) is a chemotherapy drug that is given as a treatment for some types of cancer. It is also known as Tomudex®. It is most commonly used to treat cancer of the large bowel. This information describes raltitrexed, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

What raltitrexed looks like
How it is given
Possible side effects
Less common side effects
Additional information

What raltitrexed looks like

Raltitrexed is a colourless fluid after being dissolved from powdered form.

How it is given

Raltitrexed may be given:

as a drip (infusion) through a fine tube (cannula) inserted into a vein. It is given over a short period of time
through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line, which is inserted into a vein in the crook of the arm.

Possible side effects

We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Nausea (feeling sick) and vomiting If you feel sick it may begin a few hours after the treatment is given and can last for up to a day. This is usually mild and your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs that may be more effective.

Loss of appetite This is also usually mild and may last a day or so. A dietitian or specialist nurse at your hospital can give you advice on boosting your appetite, coping with eating difficulties and maintaining weight. The dietitian at the hospital can be very helpful.

Diarrhoea This can usually be easily controlled with medicine, but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Lowered resistance to infection Raltitrexed can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

Your temperature goes above 38ºC (100.5ºF)
You suddenly feel unwell (even with a normal temperature).

Bruising or bleeding Raltitrexed can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with raltitrexed you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Temporary effect on liver function Raltitrexed may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. You are very unlikely to notice any problems but your doctor will check your liver is working properly before each treatment.

Skin changes Raltitrexed can cause a rash, which may be itchy. Your doctor can prescribe medication to relieve the symptoms.

Tiredness and weakness Some people feel very tired when having raltitrexed and occasionally a flu-like illness may occur. You may have headaches, aching joints and muscles and a high temperature. It is important to let your doctor know immediately if you get a high temperature.

Less common side effects

Constipation Less commonly, raltitrexed can cause constipation, which is usually relieved by a high fibre diet or simple laxatives. Let your doctor know if you become constipated.

Taste change You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes

Hair loss This is rare with raltitrexed, but may occasionally happen. More commonly your hair may just thin. Hair loss is temporary and your hair will regrow once the treatment has finished.

Additional information

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking raltitrexed, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.