I have cancer and have been told I will need radiotherapy. I am so frightened that the radiotherapy will burn me. I have heard such a lot of stories about this. What can I do?
In the early days of radiotherapy treatment, skin burns during treatment and sometimes permanent damage or scarring of the skin, was common.
This changed during the late 1950s and 1960s as two new types of
machine were introduced to give the radiotherapy treatment. These are
called Linear Accelerators and Cobalt Units. These machines produce
irradiating rays of a much greater energy than the previous machines.
This higher energy of the rays give the treatments greater accuracy and
greater penetration of the tissues (allowing treatment of cancers deep
inside the body and also reduce skin damage. This is because the high
energy rays pass through the first centimetre or two of the first tissue
they meet, before they actually begin to give out any radiation.
Skin problems are uncommon with modern radiotherapy treatment. Occasionally skin problems can occur because of the location of the cancer and the area of the body treated. Usually this will cause no more than some temporary pinkness or redness of the skin for a week or two after treatment. If any soreness does develop it will only last a short time and can usually be eased with creams or lotions, which you will be given at the hospital. Severe or permanent skin damage is rare indeed.
The fact that skin damage was common forty or fifty years ago means that people can remember friends or relatives who had bad experiences with their radiotherapy treatments which probably account for the stories you have heard. Nowadays the situation is very different and things have improved enormously.
I am about to have a course of radiotherapy following an operation for cancer. If I go on holiday in a few months from now, will I be able to go out in the sun?
Radiotherapy is almost always a local treatment, limited to a particular part of the body. Only the skin in that area will be irradiated and the skin elsewhere will not be affected.
The doses of radiotherapy used can vary but even with quite high doses modern radiotherapy machines usually cause a little skin irritation. Even so this does mean that the skin which has been irradiated will be more sensitive to sunlight than your normal skin.
The degree of sensitivity will vary from person to person. The increased sensitivity also reduces gradually with time but probably never disappears completely.
Having had radiotherapy does not mean you must avoid the sun completely but you should take care over exposing the treated skin. It is very important to cover the treated area for at least the first year after 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 area treated will be more delicate, so extra care should be given. You should also use a high factor sunscreen (of at least factor 15). Remember, too much sunbathing does carry the risk of leading to skin cancer and should be avoided.
Very occasionally radiotherapy is given to the whole body. In this situation the doses are normally quite low but you should still take precautions in exposure to strong sunlight. Seek advice from your doctors if you are having this type of treatment.
For a long time it has been known that some cancers occur more commonly in some families than others. There are at least two possible reasons for this. It could be due to some shared environmental factor (something in the diet or something else to do with a lifestyle common to a number of family members). Or it could be due to abnormalities in the genes, which are passed from one generation to another.
In recent years research has shown that a small minority of three common forms of cancer, breast cancer, cancer of the ovary and cancer of the bowel are due to abnormal genes. There are other, rarer cancers associated with these commons cancers: there seems to be a higher risk of skin, prostate and pancreatic cancer in families with many breast and ovarian cancers. Families who have a bowel cancer gene also can have cases of endometrial, ovarian, pancreatic, stomach and kidney cancer. These genes can be passed from one generation to the next and so do account for some, but not all, of those families where these cancers are commoner than usual.
The abnormal genes do not themselves cause the cancer but they do mean that someone who has the faulty gene is more likely to develop cancer than someone who does not. So what is inherited is a greater risk of developing cancer and not the certainty that a cancer will develop. The degree of risk varies with different genes, with some it is quite small whilst with others it is very high indeed. Families that are affected by a faulty gene normally have a number of the same cases of cancer in the family, and people tend to develop the cancer earlier than usual (under 60 years).
It is true to say, however, that for the great majority of cancers, including most breast, ovary and bowel cancers, that there is no obvious family tendency and no evidence that they can be inherited. If you have two or more cases of the same cancer on the same side of your close family, you might want to talk to your GP.
There is a widespread public belief that stress can lead to cancer.
Over the last twenty years there have been many scientific studies looking at whether there really is a relationship between stress and cancer. These studies have used a number of different methods. Some have looked at women with benign and malignant (cancerous) breast lumps and compared the number of major stressful events in the five years or so before their condition was diagnosed, to see if the women with cancers had suffered more stress. Others have followed the lives of people who have been bereaved, or who were prisoners of war, to see if these stresses led to a greater chance of cancer developing in the future when compared to the normal population.
When the results of all these studies are analysed there is absolutely no evidence that stress does cause cancer.
At the end of the day stressful life events – bereavement, divorce, redundancy, moving house and so on are very very common and inevitably many people who do develop cancer will have experienced one or more of these in the few years before their tumour was discovered. Doctors often don’t know the cause of any particular cancer and people are distressed to find that there is no definite explanation as to why they developed cancer. They find it very plausible to believe that their cancer was caused by stress but there is no scientific evidence to suggest that these events are any commoner for cancer patients than for the population at large.
I have advanced cancer. I have had chemotherapy but this is no longer working. My doctor says there is no other standard treatment. I have asked her about clinical trials and she has said she will see if there are any suitable Phase II trials. What does this mean?
When a new drug is being considered as a treatment for cancer it has to go through many tests to make sure it is both safe and of benefit.
If tests in the laboratory (known as preclinical testing) have been promising then the drug can be tested in people (this is clinical testing, or clinical trials). These trials follow a set pattern through various Phases, from Phase I to Phase III or IV.
A Phase I trial simply looks at the side-effects and dose of the drug in order to work out a safe way of using it.
If the Phase I trial is successful then Phase II trials can be begin. The Phase II trials are intended to see whether the drug might be effective as a treatment against cancer.
The usual pattern for Phase II trials is for the new drug to be given to groups of people with different types of advanced cancer. Because the drug is new, and its benefits are unknown, it is usually only people who have cancers which are no longer controlled by conventional treatment who are considered for Phase II studies (since it would be wrong to give someone a treatment of uncertain value, even if it is new, when there are tried and tested treatments already available which could be helpful).
For each type of cancer which it is tested against, the new drug is initially given to about 15 to 20 people. If some of those people show an improvement as a result of having the drug then more people with that particular type of cancer will be tested to try and get a more accurate idea of how active the drug is. In this way doctors can decide whether the drug is likely to be useful and also decide which cancers are most likely to be controlled by the new treatment.
Unfortunately only a minority new drugs which reach the Phase II stage prove to be of value in cancer treatment. This means that taking part in a Phase II trial does not guarantee any benefit in terms of tumour control, and increased life expectancy. In fact it could involve a lot of extra inconvenience (with hospital visits and regular check-ups) and possible side effects from the treatment. So the chances of getting a further remission by taking part in a Phase II trial are usually quite small. Many people with advanced cancer do volunteer for these studies, partly in the hope that they may get a benefit and also to help medical science and possibly benefit other people in the future.
Another word of caution is that Phase II trials often get misreported by the media (who are always anxious for a new story about cancer). Newspaper articles, TV programmes or internet pages will often suggest that these studies are a ‘breakthrough’ or are using a ‘wonder drug’ and so, understandably, people think the drug is far more promising than is the case.
I am due to have a major operation to remove a cancer. I am very worried, because I am diabetic and need to eat regularly. Does this mean I won’t be able to have the surgery?
No. Diabetes is a common condition and surgeons are used to operating regularly on people who are diabetic. Usually they will put up a drip, into a vein in the arm or back of the hand, before the operation. This will then be used to give insulin and sugar solutions to keep your blood sugar at the correct level throughout the operation and will continue until you can eat and drink normally. Throughout this time your blood sugar level will be regularly checked and the drip adjusted as necessary. This means it will be perfectly safe for you to go ahead with the surgery that you need.
I had an abdominal operation to remove cancer last year. My surgeon is now saying that I have adhesions. What does this mean?
Adhesions are a type of scar tissue which sometimes develops after surgery.
Adhesions take the form of either strips or bands of fibrous tissue. Sometimes adhesions will cause organs to stick to one another or to surrounding tissues. Occasionally, after abdominal surgery, the bands of adhesions may interfere with the normal movement of the bowel leading to colicky spasms or even temporary obstruction (blockage) of the bowel.
Usually adhesions cause little in the way of symptoms but sometimes they can cause discomfort or even pain although this is usually only temporary. Simple pain killers, like paracetemol, or antispasmodics such as buscopan, will usually ease the discomfort which will normally disappear on its own after a short time.
In the unlikely event of adhesions leading to bowel obstruction (causing severe colicky abdominal pain, sickness and constipation) a short stay in hospital may be necessary. During this time the bowel will be rested, by giving you a drip so you do not need to eat or drink, and usually the blockage will disappear after a day or so. Occasionally it will be necessary to put a fine tube via your nose into your stomach to drain of the gastric juices (a nasogastric tube) so as to rest the bowel more completely.
Very occasionally surgeons may need to do another operation to divide and separate adhesions but they will usually try to avoid this since doing another operation raises the risk of forming yet more adhesions
My relative has been told that their treatment is no longer working and that there is nothing more that can be done, they have had lots of different treatment. Is this right, what about all the treatments I read about in the papers?
Understandably, ‘nothing more to be done’ is a phrase that can cause alarm, despondency and despair. So it is important to be clear just what this means. It isn’t the end of care and support for your relative. What it does mean is that their specialists do not think there is any treatment left that has a reasonable chance of actually controlling the cancer. There is no further ‘active’ treatment, that is treatment which is given to contain or reduce the cancer, that they can usefully offer.
This decision will change the emphasis of your relative’s medical care from ‘active treatment’ to ‘supportive care’. Their GP, Macmillan nurses and the team from the local hospice team will become more involved and you may find that the hospital will play a smaller part than before.
The emphasis of care is attention to easing, and preventing, upsetting symptoms of the cancer and giving practical support, both physically and emotionally, to your relative and the family. Quality of life will become most important and, perhaps surprisingly, people with advanced cancer often find that at this late stage of their illness their quality and enjoyment of life can actually improve.
Part of this improvement can be because they no longer have the
inconvenience of regular hospital visits and tests and the physical
effort and burden this may involve when faced with an advanced cancer.
Less disruption to a person’s daily life, and not having to cope with
the often unpleasant side effects of treatment can be a benefit,
particularly if the treatment is not helping to control the cancer.
It is natural to feel despair when the specialists say there is nothing more that can be done. So your question is one that is frequently asked. Very often, however, it is asked by relatives and not by the person who actually has the cancer. Sometimes this is because that person has come to terms with their condition and is quite willing, and possibly even relieved, to go along with the change in their care. At the same time their relatives, with the best of intentions, still feel they shouldn’t ‘give up’ and that ‘something must be done’. If your relative is still looking for active treatment there are two things they can do.
The first is for your relative to talk to their specialist (a phone call to his or her secretary should easily arrange this). They can ask about any experimental treatments and clinical trials that may be suitable. It may be that they will say there really is nothing to be offered or they may tell them about new or experimental treatments which are being tested at another hospital and might offer to refer your mother there for advice.
There are always new drugs and treatments being tested for cancer, unfortunately many of these do not prove to be successful or the benefits are likely to be small. Despite this reality, many new experimental treatments do get enthusiastic reports in the media, which all too often raise false hopes for patients and their families. Sadly this happens frequently.
However having active treatment helps some people feel positive and hopeful even though they know the chances of benefit are small. People sometimes find it easier to cope if they feel they are doing something active to try and treat the cancer, and many people are also happy to be contributing to the advancement of knowledge about cancer and its treatment. The downside is the disruption, and possible distress, from treatment and its side effects that your relative might have to go through. Also, even when there is a response to these treatments it is, at best, usually a matter of prolonging life by a few weeks or months.
If your relative doesn’t want to see the specialist, or if they feel the interview was not satisfactory, then the second thing you or they can do is ask the consultant or GP to arrange a second opinion from a consultant at another hospital. Doctors are usually happy to do this, as they appreciate a persons need to find any available treatment that may help. Even if you do this, however, it is likely that the new specialist will not be able to offer anything more. But at least you will then know that they have explored every possible avenue for their future care.
My husband has been told he has incurable cancer. I have asked the doctor how long he might live but his answers seem very vague. Why can’t he be more precise?
When someone has incurable cancer it is very natural that their relatives want to know how long they might live for (even if the patient themselves does not want to know) so that they can plan and start to come to terms with such a distressing situation.
Unfortunately it is usually difficult, even for the most experienced cancer specialist, to give an accurate answer. This is because every patient is a unique individual and will be affected differently by their illness. Even two people of the same age, with the same type of cancer, which has spread to the same extent, can have very different survival times. This can happen because many other things influence survival including general fitness, will power, the response to treatment and the development (or avoidance) of unexpected complications.
Despite all this, if the doctor knows the type of cancer and how far it has spread then they will be able to offer ‘average’ figures for life expectancy. But, very importantly, these are only averages. This means that some people will live a little longer, and a few will live a lot longer, than predicted, whilst others may survive a shorter time.
So, in many ways, even an expert opinion of life expectancy for any individual patient is little more than informed guess.
Sometimes, however, even if doctors explain the uncertainties, patients and their relatives will still put great faith in the time they have been given. (This can then lead to problems if someone deteriorates sooner than expected).
Because of this uncertainty some doctors are reluctant to offer survival times to their patients (or to relatives). Most specialists, however, will be prepared to discuss the issue, realising that people do need some idea of time scales in order to plan their lives and cope with things. But their advice is still only a guide to what might happen and not a precise forecast of what will happen.