Skin Cancer

Radiation therapy

Radiation therapy can be used to treat both melanoma and NMSC. Most people with melanoma will have surgery but some people with widespread in situ melanoma, or with metastatic lymph nodes after surgery may be referred to a radiation oncologist to consider having radiation therapy.
 
The common type of radiation therapy for skin cancer is called external beam radiation therapy. This type of radiation therapy is applied from outside of the body. The machines used to deliver radiation therapy for skin cancer give less penetrating radiation that is because these skin cancers are on the skin surface. Some people will need deeper treatment with deeply penetrating x-rays called megavoltage photons.
 

Radiation therapy can be used in the following ways: 
Definitive  is used on its own (without surgery) to cure skin cancer. It may be recommended if surgery is not appropriate because of the size and location of the skin cancer or an operation is not safe for the person involved. This therapy is more common for people with a NMSC.
Adjuvant  is done after surgery. It is used as an additional treatment to kill any cancer cells that may not have been removed during surgery.
Palliative 

is used to relieve symptoms of advanced skin cancer, such as pain and bleeding or if the cancer has spread to other parts of the body such as the bones.

How do I prepare for radiation therapy? 

You will meet with many members of the cancer care team, who will help you learn how to look after yourself through radiation therapy, recovery and long term follow-up. They will also talk to you about side effects and how to manage them. It may be helpful to write down questions as they come up, so you can ask anyone in your cancer care team when you see them.

 

Radiation therapy mask-making and simulation 

  • Radiation therapy is a precise treatment. In order to make sure, that the cancer is covered by the treatment, you will need to be very still during the treatment, usually for about five minutes. A radiation therapy mask that is made to fit perfectly to your shape, will be put on you during each treatment to help the machine target where the cancer is.

  • You will have a planning CT scan (and sometimes other scans) with the mask on. Your radiation oncologist and radiation therapists will use these scans with all your other clinical information to develop a radiation therapy plan just for you (a personalised plan). Your plan will be checked by the radiation therapy and radiation oncology physics team before it is ready to be used for your treatment. This whole process can take approximately 2-3 weeks.

 

Teeth and mouth care

You might need to have some of your teeth taken out, this will depend on the area being treated and the dose of radiation therapy. It is important to take out any broken or infected teeth before radiation therapy. Taking out unhealthy teeth after radiation therapy can cause problems with the jaw bone.  Further information about removing teeth and what to expect during and after the operation is available here

 

 

Diet, nutrition and the role of your dietitian

Your cancer and its treatment can make it hard to eat and drink. Your doctor will recommend you see a dietitian to maximise your nutrition during treatment as well as while you are recovering. Sometime feeding tubes may be recommended depending on the area being treated and the dose of radiation therapy.
There are two common types of feeding tubes: 

  • Gastrostomy tube (sometimes called a PEG tube): this type of tube is inserted through your abdominal wall into your stomach, with part of the tube staying outside the stomach.  A syringe can be attached to the tube to give you food this way if needed. The tube is inserted using a camera through the mouth into the stomach (gastroscopy) or using a CT scanner to guide insertion directly through the skin. If a PEG tube is needed, your doctor will organise this before starting your radiation therapy

  • Nasogastric tube: this type of tube goes through the nose down into the stomach and is usually used for short periods (days or weeks). A nasogastric tube can be inserted at any time (before, during or after treatment).

 
  
  There are many other aspects of supportive care that will available to you, ask your doctor if you have any specific needs  

Side effects

The side effects of radiation therapy can start during treatment and progress through treatment to peak at the end of treatment and the week after treatment. They begin to improve 2-3 weeks after the end of treatment.

Side effects associated with radiation therapy depend on:

  • the dose of radiation therapy

  • the area being treated

  • whether or not chemotherapy is added to the radiation therapy

  • how quickly the treatment is delivered.

Common early side effects of radiation therapy may include:

  • tiredness

  • skin irritation in the area treated- redness, dryness and itching, weeping skin, scaling or even skin breakdown by the end of treatment

  • local loss of beard (in men) or hair if the scalp are treated

  • nasal cavity crusting, congestion and bleeding of nose is treated.

Most side effects are short lived and may go away shortly after you finish radiation therapy. Some side effects may last for some time after you finish radiation therapy and some may be permanent.

Once your radiation therapy ends, you will have regular have follow-up appointments, so that your doctor can check your recovery and monitor any side effects that you may have.

Your doctor may recommend specific supportive care options to help you during your treatment and recovery.