Radiotherapy centre - woman with cancer embracing adult

Support Therapies To Help Cancer Patients With Recovery

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Cancer treatment is improving all the time, but for the best results, action needs to be prompt and aggressive. Doctors will advise either a course of chemotherapy, surgery to remove the tumour, treatment at a radiotherapy centre, or often a combination of the above for the best chances of survival. 

While these intense treatments are necessary to shrink the size of the tumour or eradicate it entirely, they need to be undergone in conjunction with other support therapies, as patients need more than just medication to get over their cancer experience.

As radiotherapy, chemotherapy and surgery can be depleting, it is important to have the right support in place to build patients back up, both physically and mentally, so they can make a full recovery. 

Additionally, it means the years they have added to their lives through the invasive treatments can be worthwhile, as they have been able to keep their bodies fit and healthy and have managed to mentally cope with the trauma of facing their mortality. 

What are support therapies?

Unlike chemo or radiation therapy, which kill the cancerous cells in the body, support therapies look after the patient when they are undergoing this intensive treatment. 

This helps them respond to medication better and enables them to feel mentally and physically strong during this difficult time.

Mental health support

One of the most important forms of support for cancer patients is being able to talk to a counsellor about what they are going through. 

It can be an extremely anxious time for patients, who naturally think the worst, so it is usual to feel very apprehensive and stressed.

Many people also fall into depression, as they may lose hope after multiple treatments or struggle to cope with the harsh side effects of chemotherapy, which can include sleep problems, sickness, and fatigue. 

Other symptoms, such as anaemia, infections, hair loss, nausea, weakness, loss of appetite, mouth sores, and memory problems, can also be difficult to deal with, leaving some patients feeling extremely low. 

Cancer is very difficult to deal with emotionally, from receiving the diagnosis to completing treatment and everything in between. 

Not only are patients instinctively scared, but not being able to feel like their usual self, being angry that this happened to them, holding guilt their loved ones have to go through this too, and feeling lonely and that nobody can relate, can be particularly difficult to handle for many. 

So it is important to speak to a therapist about the trauma, and any raw emotions it brings up. 

It is also a difficult time for the rest of the family, which is why having sessions together can be helpful as well. 

Nutritional guidance

Cancer, as well as the curative treatments, can take a big toll on the body. Therefore, the best way to boost recovery is to look after it as much as possible. 

Diet plays a huge part in this, as it is essential to get the right nutrients to fuel the body properly, so it can regain strength and recover fully and quickly. 

Having nutritional support is, therefore, sensible, as experts can provide dietary guidance to make sure the patient is getting the vitamins, minerals, proteins and carbohydrates they need. 

They also help to manage weight, making sure patients do not lose too much if they are being sick or lose their appetite, as malnutrition is often seen among cancer patients, leaving them weak and unable to fight infections.

Conversely, they can guide people to lose fat at an appropriate rate, if this is deemed beneficial for their recovery. 

Nutritionists and dieticians can also advise what foods to eat to boost the immune system, which is essential as this will be extremely low after the treatments, and what meals may be easier to stomach if vomiting and nausea is a problem. 

The National Cancer Institute recommends:

  • Eating high-protein foods to make sure protein targets are met.
  • Swapping solid foods for milkshakes, smoothies or soups if swallowing is difficult. 
  • Consuming small meals throughout the day, as this is easier to stomach.
  • Having foods that are bland, gentle on the stomach, and easy to digest. 
  • Eating dry foods, such as toast and crackers, particularly first thing in the morning when nausea can be worse.
  • Having food at room temperature, instead of hot or cold. 
  • Avoiding skipping meals, as this will make sickness feel worse.
  • Rinsing your mouth after eating and in between meals. 
  • Sitting upright after vomiting to avoid it happening again. 
  • Sipping water throughout the day. 
  • Eating soft foods if mouth ulcers are a problem. 
  • Avoiding citrus, acidic, salty, or spicy foods. 

What type of food patients will be able to hold on will depend on them individually, but as long as they make sure their diet is full of whole grains, vegetables, fruits, protein, healthy fats, dairy or a dairy substitute, and water this will help improve their recovery and make them feel more energised and stronger.

Mind-body therapies

Many people really benefit from mind-body therapies, as this enables them to relax during a difficult time, improve their overall wellbeing, and reduce side effects.

These include the likes of meditation, art therapy, music therapy, yoga, tai chi, hypnotherapy and other relaxation techniques. 

The benefits of these include reducing anxiety and stress, feeling less anxious or depressed, being able to cope with chronic pain better, feeling more relaxed, being able to express their feelings, improving self-confidence, and helping with fatigue. 

Yoga has also been found to help patients to sleep, with insomnia being a common symptom, help patients feel stronger mentally and physically, and make them feel less tired. 

Acupuncture

Some patients find acupuncture very helpful when they are undergoing cancer treatment, as this can relieve some of their unpleasant side effects and relieve pain. 

Those who have a weakened immune system or a low number of platelets due to their treatment should avoid acupuncture, despite its benefits, as they are at greater risk of infection and bleeding. 

However, those who are able to receive the therapy might find it helps boost their flow of energy and, as it releases endorphins, it can relieve pain and improve patients’ moods.

radiotherapy - Nurse Puts a Dropper

‘Preventative Chemo’ Explained Amid Kate Middleton Diagnosis

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The British Royal Family shocked the world recently by releasing a video statement from the Princess of Wales, Kate Middleton, revealing she had been diagnosed with cancer and was now undergoing a course of preventative chemotherapy. 

While the 42-year-old did not specify what type of cancer she had, she explained it had been discovered following major surgery in January this year. 

Despite the surgery being successful, tests found that cancer had been present in her body, and to eliminate any chance of it recurring she needed to receive cancer treatment. 

Although many people who have themselves had a cancer diagnosis in the past might know what preventative chemotherapy is, for others, here is an explanation of this course of treatment. 

Preventative chemotherapy explained

Preventative chemotherapy is not actually a medical term, and oncologists are most likely to refer to it as adjuvant chemotherapy instead. However, the Princess of Wales most likely used the former phrase as it is more self-explanatory. 

Adjuvant chemotherapy involves using chemotherapy drugs to eradicate any of the remaining cancer cells that might still be in the body. 

The surgeon, for instance, might not have successfully removed all of them when they extracted the tumour, or the cells might have spread to other parts of the body without yet being detected. For instance, sometimes tests fail to pick up on microscopic cancers, so it is better to be safe than sorry in these incidences.

It is, therefore, used to prevent the cancer returning, as the cytotoxic drugs can attack any remaining cells and destroy them, wherever they are in the body. 

Preventative chemotherapy is not used in every case, but only when the medical team believes the risk of recurrence is high. 

Doctors choose the best treatment path for each patient, whether that is chemotherapy, radiotherapy or another procedure, weighing up the risk and benefits of each action. 

If they believe there is still a risk there could be cancer cells in the body that are able to spread, it is likely they will advise on a course of chemotherapy to remove this risk and achieve a better prognosis for the patient. 

What type of cancers does preventative chemotherapy work best for?

Whether medical experts choose to go ahead with adjuvant chemotherapy also depends on the type of cancer present in the body. 

It is more successful with particular types of cancer, such as breast and colon cancer, for instance.

They will also consider other factors, such as the stage of the cancer, the number of lymph nodes involved, the hormone receptivity, and changes within the cancer cell.

Someone whose cancer is at the very early stage might not need adjuvant chemotherapy as the cancer has not had a chance to spread yet. So it is more likely to be given to a patient whose cancer has spread to nearby lymph nodes.

If there are a lot of lymph nodes involved, there is a greater chance cancer cells would have been left behind after surgery to remove the tumour. 

How many treatments will it involve?

The number and course of the treatment will be specific to the patient, as the type of cancer, its stage, and the overall health of the person could affect how the chemotherapy is administered and how many procedures are required.

Generally, chemotherapy will be undertaken for between four to six months, with their treatment being split into cycles. For example, patients might have to undergo six cycles, with a few days of chemo and some days of recovery before the next one. 

In many cases, one course of treatment should be sufficient to remove the risk of cancer in the body. However, this depends on how well the patient has responded to the chemotherapy. 

What are the side effects?

Just like other chemotherapy treatments, patients will face a number of unpleasant side effects. 

As it targets healthy cells, as well as the cancerous ones, it can take a huge toll on the body. Subsequently, the following side effects are common:

  • An increased risk of infection
  • Anaemia
  • Brain fog, poor concentration and declining memory
  • Diarrhoea or constipation
  • Mouth ulcers
  • Reduction of appetite
  • Nausea and vomiting
  • Hair loss
  • Hearing loss
  • Pins and needles in limbs
  • Reduced sex drive
  • Infertility
  • Sensitive skin or rashes
  • Dry, brittle nails
  • Fatigue 
  • Breathlessness
  • Nosebleeds or bleeding gums 

What is the recovery time?

Patients who are undergoing preventative chemotherapy can expect it to take a few months before they fully recover. Not only do they have to wait for the side effects to calm down, but they are also likely to still be recovering from their surgery. 

After waiting for the course of chemotherapy to finish, they will need some time for their body to gain strength again before they can feel their usual selves. Having cancer will also have a huge impact on their mental health, so it is important patients look after their emotional, as well as their physical, wellbeing.

radiotherapy centre - doctor and testicular cancer patient

How Does Cancer Spread To Other Parts Of The Human Body?

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A course of radiotherapy is undertaken through extensive, cautious planning to ensure that it has the greatest effect possible to relieve pain, prolong life and improve the quality of everyday existence.

When someone enters a radiotherapy centre to undergo consultation and treatment, each case will have some unique elements to it, and whilst treatments such as stereotactic radiosurgery are focused predominantly on removing tumours and lesions based in the brain, this does not mean they necessarily originated there.

Cancers can spread in a process known as metastasis from one part of the body to the next, and understanding how this process works is important for understanding its implications on treatment.

Primary And Secondary Cancers

Oncologists will make an important distinction between a type of cancer and where it currently is in the body, which is important to avoid confusion when discussing a person’s condition.

For example, if someone has breast cancer that spreads to the brain, it will still be called breast cancer even though it is not located in the breast. The cells in the brain that are cancerous are breast cancer cells, not brain cancer ones

This concept is known as primary and secondary cancer. A primary cancer is one that originates in the place where the tumours are found, whilst a secondary cancer is where that cancer has spread elsewhere.

This is an important distinction to make because there are many different types of cancer, each of which has different methods of diagnosis, treatment and prevention that need to be used to manage it effectively, particularly when it comes to medication and chemotherapy used alongside radiotherapy.

Generally, a secondary cancer of the brain is found by examining an existing primary cancer, but there are times when the primary cancer no longer exists in the body, either by being removed or destroyed by past treatment, or being too small to be easily detected.

Whilst there are cases where oncologists can determine the type of cancer from the types of cells that comprise them, there are some cases where doctors cannot completely verify the original location or doing so would require intense tests that may not change the planned treatment. 

These are known as cancers of unknown primary and happen either due to a small primary cancer, a primary cancer that has already been destroyed by the immune system, or complexities with treatment that mean that certain tests cannot be used.

How Cancer Spreads

Cancer spreads through the body through either the blood or lymphatic system, which regulates and filters other bodily fluids.

A primary cancer growth spreads largely by breaking apart. Cancer growths are often unstable, and cells can break away or be stimulated to travel elsewhere.

From there, they find a way into the bloodstream, where they are swept along by the blood or other fluid until they get stuck in a tiny capillary. The cell then moves through the wall of the blood vessel and enters nearby organ tissue. 

If they have the right nutrients and conditions to grow, the cancer cells will form a tumour in the new location.

This is a very difficult process and whilst a lot of cancer cells will break off and enter the bloodstream, few will complete the process of forming a secondary cancer.

The blood flow itself can be powerful enough to destroy cells, whilst white blood cells in the blood can kill some of the cancer cells it finds.

Alternatively, cancer cells can spread through lymph vessels close to the primary tumour. This allows them to flow into lymph glands designed to drain damaged cells and excess bodily fluids.

If they survive this process, they can sometimes form tumours in a lymph node, and a swollen lymph node can sometimes be a marker for cancer, although lymph nodes can also swell due to the effects of infection.

Can Any Cancer Spread To The Brain?

Theoretically, any cancer can have a secondary growth in the brain, although some cancers are more likely to than others due to how relatively common they are.

These include:

  • Breast cancer.
  • Lung cancer.
  • Bowel cancer.
  • Kidney cancer.
  • Melanoma (a type of skin cancer).

Because these are common cancers, and their effects are well-known, secondary brain cancer can often be treated, particularly if it is found quickly.

Radiation therapies such as Gamma knife work as well for secondary brain cancer as they do for primary ones, and they can be used in combination with targeted drugs, chemotherapy and surgery to relieve pain and long-term effects.

How might intensity modulated Radiotherapy help you?

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Patients who have had a cancer diagnosis may soon find they are discussing a range of treatment options that includes radiotherapy. But while most lay people will have some idea of what radiotherapy is and how it works – usually because they know somebody who has been treated that way – not many will know about the different versions of the treatment.

What the lay person generally knows is that radiotherapy involves using radiation to kill off cancerous cells and tumours, not by zapping them like some laser, but by damaging their DNA so their cells cannot divide and grow.

However, because radiotherapy involves doses of radiation that can also harm DNA in healthy cells and tissues, with a range of side-effects, plus the fact that a more concentrated and accurately directed beam that is better focused on the target area brings better results, specific kinds of radiotherapy treatment can achieve more.

How IMRT Works

Intensity Modulated Radiotherapy, or IMRT, is a case in point. This is a treatment delivered using linear accelerators controlled by computers, which will deliver a very precise level of radiation to a tumour or even a particular part of the tumour.

The radiation is delivered in small volumes and comes from different angles, highlighting the reality that while scans and images may come out in 2D, tumours exist in 3D and hitting the right spot each time means delivering each dose to the exact spot where it is most needed. Often this is done by using multiple beams simultaneously delivered from different directions.

To ensure this can be done with accuracy, 3D tomography is used in the preparation for the procedure. This will enable the tumour to be mapped out in 3D and the specific areas that need the most intense and precisely calibrated doses of radiation to be identified and their positions pinpointed.

The scanning for this is done by MRI and the calculated dose is worked out by computer, bringing to bear the latest and most advanced complementary technologies to help ensure this form of radiotherapy is delivered in the most adroit and precise manner, something almost unimaginable when radiotherapy was first used in the 1900s.

What IMRT Procedures Involve

All this makes the treatment a lot more complex than other ways of delivering radiotherapy, which necessitates more checks and preparation for treatment, while the treatment itself will last for longer.

However, because there is such a contrast in the dosage received by tumours (where it needs to go) and by surrounding healthy tissue (where you don’t want it to go), it also enables stronger doses of radiation to be deployed in attacking tumours, making it more likely to be highly effective.

What all this means is that some specific forms of cancer are better treated with this kind of radiotherapy, with the patient having to lie still in a particle accelerator while the doses are delivered over a period that may range from 15 minutes to an hour. For those prone to claustrophobia, it can be unpleasant, but life-saving.

New Research Breakthrough For IMRT

The benefits of IMRT may be about to grow as new research has shown how it can be used to achieve a ‘gold standard’ of treatment for those suffering cancers of the head or neck and help avoid dysphagia, a condition where a person has difficulty swallowing.

A trial at the Royal Marsden Hospital in London, co-ordinated by the Cancer Research Trust, set out to compare the side effects of dysphagia-optimised intensity modulated radiotherapy (DO-IMRT) with standard forms of IMRT.

A key side-effect issue that can occur in this case is that the delivery of radiation to the muscles involved in swallowing can cause dysphagia. Some patients may need to have a permanent feeding tube inserted.

The study compared how often newly-diagnosed throat cancer patients treated with each form of IMRT suffered dysphagia. The result, published in the Lancet, was that of the 112 patients, half of whom received DO-IMRT and the others standard IMRT, there was a clear difference in the ability to swallow.

Among the DO-IMRT group, 62 per cent were able to eat at least some food that needed chewing and 85 per cent felt comfortable eating in public. In the other group, the respective figures were 45 per cent and 75 per cent. All this happened while there was no significant difference in the three-year survival rate between the two groups.

This discovery means that, in future, IMRT for patients of neck and head cancers can be delivered in an even more precise manner, in order to further limit its side effects without having any negative impact on patient outcomes.

How to help patients enjoy Christmas during cancer treatment

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Cancer treatment takes a physical toll on patients, leaving many with fatigue, nausea, vomiting, and difficulties eating and drinking.

This is hard at any time of the year, but particularly over the Christmas period.

While they might want to join their family and friends with the festivities or enjoy a Christmas like they’re used to, feeling so physically unwell can throw their plans into disarray.

If you want to help a loved one who is going through chemotherapy or radiotherapy treatment throughout December, here are some ways you can still give them a Christmas they can enjoy.

Watch lots of Christmas movies

One of the most common side effects of cancer treatment is fatigue, so do not expect your loved one to be up to much over the festive period.

Instead of going to parties, family gatherings, carol concerts or Christmas markets, you can join them in watching lots of festive films on TV.

This will allow them to still feel involved in seasonal activities while also being able to catch up on much-needed rest.

They can feel part of the festivities without having to leave their living room, and by keeping them company, they can avoid feelings of loneliness that often arise at Christmas.

Think carefully about food

Although most people love all the foods and treats they can indulge in at Christmas, eating can be very difficult for people who are undergoing cancer treatment.

They might have a sore mouth if they have had radiotherapy to their head or neck, which can make it feel as though their mouth is burned or very dry. They might also have mouth ulcers, or discomfort when trying to eat or swallow.

In these cases, it is important to avoid spicy or salty foods, as these can make the pain worse.

At the same time, they might have a reduced sense of taste or their appetite may have disappeared.

Many people feel nauseous after treatment, vomit or have diarrhoea or constipation, in which case they will not want to eat all the rich foods they would have normally loved at this time of the year.

If your loved one is suffering with their eating, try to find something they can stomach or find comfortable to swallow. This might mean drinking instead of eating, having five or six smaller meals instead of big ones, or only nibbling on snacks.

Give them a small taste of their favourite Christmas foods on the days they are feeling better so they do not feel left out, but keep their diet plain and simple the rest of the time.

Go for festive walks

They might not have the energy for high-octane Christmas activities, but it is still important they do some exercise, as this can improve their appetite and boost their energy levels.

Taking small walks with them will not only help them feel better, but it can make them feel festive looking at the Christmas lights or wrapping up warm against the chill.

You could even give them cosy socks, heated gloves or fleece hats that will help them remain comfortable even if it is freezing cold outside.

Limit visiting times

Visitors love to pop in over Christmas, especially if they want to send their best wishes to the patient.

However, it can be very tiring having lots of people around, particularly if they feel like they should be hosting their friends and family over the season.

That is why it is a good idea to remind loved ones they should keep their visits short and sweet. They should also not expect to be served upon or entertained while they are there.

Those who do visit should also be reminded of appropriate gifts to bring, instead of alcohol, chocolates, or flowers, which can carry fungal spores that are dangerous for those with a suppressed immune system.

Some options are cosy clothes or blankets; stress relievers, such as eye masks or scented pillows; audio books; or a basket with items such as scent-free skin creams and lip balms, magazines, tea or candles.

Although having a conveyor belt of guests is tiring, it can remind cancer patients of how much they are loved. It can also make them feel more involved in Christmas festivities, as long as they are given enough time to rest before and afterwards too.

This Christmas might not be quite like their usual ones, but by creating some pleasant moments each day, you are helping them get through the difficult season and, ultimately, aiding their recovery in the long-term.

What are the negative side effects of having Radiotherapy?

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Cancer treatments have to be strong and powerful to have the best chance of killing off cancerous cells and improving the chances of making a full recovery.

However, the downside to this is while they are designed to have as much impact as possible, this can also mean patients have to endure some unpleasant side effects.

When it comes to radiotherapy, the repercussions of the treatment varies from person to person, depending on the type of cancer, its stage and grade, and the health, age and weight of the patient.

Before learning what the most common side effects may be, it is important to fully understand what radiotherapy is and how it is used to treat cancer.

Radiotherapy explained

Radiotherapy works by using radiation rays to destroy cancer cells in the targeted area.

It is often used in the early stages of cancer to cure it completely, or in conjunction with chemotherapy to make the combination of treatments more effective. Some patients may also receive radiotherapy before surgery to reduce the size of the tumour to make it easier for surgeons to remove it all.

Sometimes doctors assign a course of radiotherapy after surgery as a preventive measure to reduce the chances of the cancer returning.

However, it can also be used in the later stages of cancer if a cure is not possible. This treatment, which is known as palliative radiotherapy, helps to relieve the symptoms of cancer, and slows down the spread of the cancerous cells.

Although the radiation rays are administered by a machine to carefully target the affected area, they can frequently damage healthy cells too. This is what leads to patients suffering from adverse side effects.

The main side effects of radiotherapy

As previously mentioned, the severity and types of side effects experienced after radiotherapy is dependent on different factors. However, the most common ones are:

  • Skin reactions
  • Fatigue
  • Hair loss
  • Nausea and vomiting 
  • Problems eating and drinking
  • Diarrhoea
  • Changes in bleeding

Skin reaction

As a result of the external beams, skin reactions following radiotherapy are common. Patients often find their skin becomes red, sore, itchy or darker around ten days after treatment.

The affected area may even blister or leak fluid, but it should improve after a few weeks.

To soothe sore skin, it is wise to avoid certain products, and simply wash it gently with soap and water. Wearing loose-fitting clothing from natural fibres, protecting the area from the sunshine, avoiding using heating or cooling pads and pat drying is also advisable.

Fatigue

Radiotherapy fatigue typically worsens throughout the course of treatment. Usual daily activities may begin to feel too exhausting, which might continue for a few weeks or months after treatment has ended.

Those who have a combination of chemotherapy and radiotherapy could also experience more fatigue.

To combat this tiredness, give yourself a break and make sure you get plenty of rest. Make sure you get help with daily tasks, eat healthily to keep your body fueled, and do gentle exercise, such as short walks, to boost energy.

Hair loss

Hair loss from radiotherapy is typically only from the area being treated. Hair tends to fall out two to three weeks after the start of treatment and should start to grow back a little while after it has finished.

Those with a high dosage of radiotherapy may experience permanent hair loss in the targeted area.

If the hair loss is on your head due to a brain tumour, you may want to wear a wig or a headscarf if you are self-conscious about it.

Nausea and vomiting

Those who are having radiotherapy near or on their stomach or brain are more likely to experience nausea and vomiting.

Patients should tell their doctor if they feel sick, as they can be prescribed anti-sickness drugs. It is also helpful to sip drinks slowly and ask loved ones to help you prepare meals.

Problems eating and drinking

It is usual for people to experience problems eating and drinking after radiotherapy, as they may have a sore mouth, suffer from a loss of appetite or find it hard to swallow.

Radiotherapy can cause the inside of the mouth to feel sore, become dry, or have mouth ulcers. It may also be harder to swallow food if you have had treatment to the head, neck, oesophagus or chest, and a diet of soft or liquid foods may help shortly after treatment.

Some people also lose their appetite due to nausea, fatigue and a reduced sense of taste. Eating small meals throughout the day could prevent weight loss, so patients can remain fit and well while they are undergoing treatment.

Diarrhoea

Those who have had radiotherapy on their pelvic area or their stomach are likely to have diarrhoea after their treatment.

This can be very uncomfortable, so patients should ask their doctors for medicine to ease their symptoms.

Changes in bleeding

If you find you have nosebleeds, bleeding gums, blood in your urine or stools, heavy periods or red spots on the skin, this could be a sign that the radiotherapy has reduced the number of blood cells produced by your bone marrow.

Though this will start to normalise after the end of treatment, patients who have symptoms of an infection should contact their doctor straightaway.

Other side effects

While these are the most common side effects, there are others that can occur.

For instance, those whose brain tumour is being targeted might suffer from memory or concentration problems, blurry vision or headaches.

Patients whose pelvic or rectum is having radiotherapy could face sexual, urinary and bladder problems and, potentially, long-term fertility difficulties.

Despite the unpleasant symptoms, this form of cancer treatment is one of the most reliable and widely available.

That is why those who have been given a diagnosis should not hesitate contacting a radiotherapy centre to book in their treatment as soon as they can, as eradicating the cancer and increasing life expectancy is, for most people, worth the negative side effects.

What is the difference between Adjuvant and Neoadjuvant?

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Every case of a person seeking a consultation at a radiotherapy centre is somewhat unique, and as a result, the treatment pathway will often be designed and tweaked based on their individual needs and the complexities of each treatment.

However, whilst there are hundreds of different types of cancer, each of which can progress in different ways and at varying speeds, there are typically four particular scenarios where radiotherapy is used.

The first and most directly effective treatment is radiosurgery, where radiation is carefully targeted to destroy lesions and tumours. This was initially primarily used for brain tumours but can be used for tumours in any part of the body if the treatment is suitable.

The final type of treatment is palliative radiotherapy, used for the opposite purpose of radiosurgery.

In cases where a tumour cannot be safely operated on or where treatment would be ineffective, radiotherapy can help to reduce the size of tumours and as a result, also reduce pain and other symptoms.

However, there are two other types of treatment that are both in the middle of this treatment pathway, known as adjuvant and neoadjuvant.

Both are used alongside conventional surgery to cut tumours away from the body, but both are used at different times and for very different purposes.

Adjuvant Radiotherapy

An adjuvant treatment is a type of care used to enhance the effect of a surgery or other primary care pathway.

In the case of adjuvant radiotherapy, it is used after a surgical treatment has cut out a cancer to destroy any remaining cancer cells to stop the cancer from growing back from just a few cells.

It is not always used, and if it is a recommended treatment, it will typically be carefully considered by an oncologist before it is recommended.

Neoadjuvant Radiotherapy

A neoadjuvant treatment also works to enhance the effect of an existing primary therapy, but instead of taking place after this main treatment, it is undertaken before the main intervention.

Because of this, the motivation behind neoadjuvant treatments is to make the surgery or other primary care easier to execute, more likely to be completed successfully and with fewer side effects.

In neoadjuvant radiotherapy, this is used to shrink the tumour down in size, making it far easier to excise in surgery and often shortening the procedure’s length.

In some cases, neoadjuvant radiotherapy can turn an inoperable tumour into one that can be treated without significant harm to surrounding organs, tissue or structures.

Much like adjuvant radiotherapy, it is not always an option and would be discussed carefully by an oncologist and specialist radiotherapist, detailing the clear details of the treatment before progressing further.

Can You Have Both?

In some cases, a patient may have both neoadjuvant and adjuvant radiotherapy during the same course of treatment.

Often, this is done based on the response to the neoadjuvant therapy, tailored based on the response of the cancer to ensure that the overall treatment is as effective as possible and this effectiveness outweighs the effects of the triple treatment.

How Radiotherapy can tackle Prostate Cancer scourge

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Prostate cancer is one of the most common cancers that are specific to men. It is often poorly understood, yet it is also often very treatable, especially if it is caught at an early stage.

Indeed, the UK government chose the occasion of International Men’s Day (November 19th) to announce the launch of the biggest prostate screening trial in Britain for decades, named TRANSFORM. It is the only cancer in the UK that does not have a national screening programme and 12,000 patients die from it every year, while 52,000 are diagnosed with the disease.

A New Hope For Diagnosis?

The screening will use new scanning techniques like MRI scanning to detect prostate cancer. This is expected to deliver much more accurate and reliable results than the current standard method of blood tests, which can often fail to diagnose cancer and also give false positives.

Commenting on the trial, secretary of state for health and social care Victoria Atkins said: “Our hope is that this funding will help to save the lives of thousands more men through advanced screening methods that can catch prostate cancer as early as possible.”

As with other cancers, failure to catch the disease early means eliminating it is harder and in some cases impossible. The government announcement of the trial featured the case of 58-year-old patient Daniel Burkey, who was unfortunate enough to have been diagnosed late.

He said: “Men need prostate cancer screening so that if we’ve got it, we can find out early enough to treat it and get rid of it. I got my diagnosis in my fifties, and the doctor told me the horrible news that it can’t be cured.”

What Radiotherapy Can Do

Mr Burkey is receiving a range of treatments to slow the cancer and extend his life, which includes radiotherapy. But for some patients in Europe and across the world, even getting this treatment can be hard. Not everywhere has a radiotherapy centre, let alone one that offers outstanding treatment using the best-in-class equipment and clinical expertise.

The way radiotherapy commonly works in treating prostate cancer is by using external beam radiotherapy, rather than a gamma knife. This can be used either on localised prostate cancer (where it has not spread beyond the prostate) or non-localised cancer (where it has spread).

It involves killing the cancer cells through direct beams of radiation, although this can also damage other cells. However, other cells can repair themselves after. During the process, however, this can bring various side effects, ranging from hair loss and fatigue to urinary problems and a loss of sexual function.

The aim of radiotherapy in the case of a localised infection or a recurrent one is the elimination of the cancer. Early diagnosis that captures the disease before it spreads gives the best chance of achieving a complete cure.

Wider Uses Of Radiotherapy

It can also be used in a wider area. This can include the seminal vesicles, the semen-producing glands next to the prostate, while the treatment can also cover the area just around the prostate, including the nearby lymph nodes.

As ever with cancer, lymph nodes can be critical to the eventual outcome. Once any cancer reaches the lymph nodes, it can spread more rapidly, so localised radiotherapy can extend to nearby pelvic lymph nodes.

Once it has spread further, the purpose of radiotherapy is to control the cancer or its symptoms, limiting its spread and effects. By this point, however, it is too late to have a chance of eliminating the cancer.

Other forms of radiotherapy include adjuvant and salvage radiotherapy, which are carried out on the area after surgery to remove the prostate.

Racial Risk Factors

The risks of getting cancer do vary, with a clear racial distinction; in particular, black men are the most at risk with one in four set to contract the disease in their lifetime, twice the risk level for other men.

As a result, the TRANSFORM screening trail, while generally focused on volunteers aged from 50 to 75, will start examining black men aged 45 and over.

However, it is not just racial factors that determine both incidences and outcomes. Writing about the topic in 2022, Science Direct highlighted the fact that variability in access to high-quality treatment can have a significant impact on outcomes.

Poles Apart

Quoting statistics from Eurocare-5, it noted the average five-year survival rate for sufferers was 83 per cent overall. However, this varied between 92.8 per cent in northern Europe and 80.1 per cent in eastern Europe, with Poland standing out as the only country with a worsening mortality rate.

Another notable fact is where Europe stands among global statistics for incidences of prostate cancer. In 2017, World Atlas published a list of the countries with the highest incidences of prostate cancer and found that European countries tended to be among the highest.

However, the worst rate among all countries was on the French Caribbean island of Martinique, at 227 per 100,000. This was one of several countries or territories in the Caribbean with high incidence rates. Others include Trinidad & Tobago in fourth, Barbados in sixth, another French territory, Guadeloupe, in 13th and Puerto Rico in 17th.

Racial demographics are an obvious factor in these locations as the populations are largely black, but that is far from the whole picture. Metropolitan (i.e. European) France is third overall and while it has an ethnically diverse population, eight other European countries make the top 20.

Of these, many are nations with very low non-white populations, including the Nordic nations – Norway (second), Sweden (sixth), Iceland (12th), Finland in 15th and Denmark in 19th. Non-European countries standing high on the list include ones historically colonised by predominantly white populations, like the US, Canada and New Zealand.

Understanding The Statistics

What these countries have in common is not just mostly white populations that are less prone to contracting the disease than nations with black populations, but the fact they are first world nations with advanced healthcare and therefore a greater capacity to diagnose cases.

This does mean there is likely to be a statistical bias in this regard, although it should be noted that the lower life expectancies in developing countries mean fewer men live to the age when they would be most vulnerable to getting prostate cancer.

Either way, for countries where diagnosis levels are high, for whatever reason, access to radiotherapy can make a crucial difference in either beating the disease or at least surviving it for longer.

How life-saving Gamma Knife Surgery became so important

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Of all the treatments we offer, gamma knife surgery is one of the most significant technologies.

A form of stereotactic radiosurgery, It enables brain surgery to be carried out in a non-invasive way, with the operation taking place quickly, very short recovery time and, crucially, delivers radiotherapy to a very concentrated area that leaves the rest of the brain untouched.

Gamma radiation itself is radioactivity produced in the form of photons, which is very high in energy. In uncontrolled circumstances, such as accidental exposure or the deliberate use of a nuclear weapon, it is a particularly deadly form of radiation. However, its power to destroy cancer cells also gives it huge oncological potential.

This was first successfully harnessed in 1967 by the Swedish professor of neurosurgery, Lars Leksell. His invention of the gamma knife, which was subsequently patented as the Leksell Knife, was transformative in treating brain tumours.

Prof Leksell and his colleague Borje Larsson had been experimenting with combinations of proton beams and stereotactic guidance since the 1950s, but this proved ineffective and it was not until the Gamma Knife arrived that they succeeded in creating the device they wanted; a non-invasive radiosurgical instrument that could blast tumours with gamma rays.

A second version of the gamma knife was built by Professor Leksell and his colleagues in 1975, but the original stayed in use for 12 years. By the early 1980s, more gamma knife units had been established, in the Argentine capital Buenos Aries and then Britain’s first unit in Sheffield. The next two appeared in the United States.

Over time the technology has been refined, but it is essentially the same device that came into being in 1967. When we use the gamma knife in our different treatment centres, we are helping patients join the many thousands who have benefitted from this extraordinary development, one that has given hope and extended life to so many neurology patients.

Chemo before CRT cuts Cervical Cancer return risk by 35%

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Taking the right course of action after being diagnosed with cancer is imperative, as the timing and combination of therapies is just as important as the type of treatment in the first place.

A recent trial

Results from a recent study have shown that giving patients with cervical cancer a short course of chemotherapy before they begin their usual treatment of chemoradiation (CRT) can reduce the risk of the tumour returning or of death by as much as 35 per cent.

The findings, which were funded by Cancer Research UK, could change the way women with cervical cancer are treated.

Over the last 24 years, they have been given a combination of chemotherapy and radiotherapy to reduce the size of their tumour and kill cancer cells.

However, the study has shown giving a six-week course of chemotherapy first could boost their chances of surviving.

Executive director of research and innovation at Cancer Research UK Dr Iain Foulkes noted that “timing is everything when you’re treating cancer”.

“The simple act of adding induction chemotherapy to the start of chemoradiation treatment for cervical cancer has delivered remarkable results in this trial,” he added.

Indeed, 80 per cent of the participants in the study, who were recruited from all over the world, were still alive five years after their treatment, while almost three-quarters had not seen their cancer return or spread to other parts of their body.

This is in comparison with the 72 per cent who were still alive after just being given CRT for their cervical cancer treatment, and the 64 per cent whose cancer had not returned or spread.

Dr Foulkes noted that this breakthrough could help with other cancers, not just cervical cancer.

He said: “A growing body of evidence is showing the value of additional rounds of chemotherapy before other treatments like surgery and radiotherapy in several other cancers.”

As the drugs are already widely available, it can be delivered quickly, helping people to eradicate the cancer as soon as possible, and increase their chances of surviving.

Subsequently, having a six-week course of chemotherapy before CRT could become a standard practice in the future.

Advances in radiation therapy

Although this breakthrough has been hailed as the biggest drug advancement in 20 years, it is not the only progression there has been for cervical cancer treatment.

Radiation therapy has also advanced over the last few years, including volumetric modulated arc therapy (VMAT).

With this technology, the strength and angle of the radiation alters as the machine rotates, so the radiation is properly targeted on to the areas of concern.

This external radiation therapy gives the tumour the maximum dose of radiation, while still minimising the dose the surrounding areas receive.

Brachytherapy is also effective, as it delivers a dose of radiation directly into the tumour. It does this by placing the seeds, ribbons or capsules into a tube, which knows the exact positioning thanks to MRI scans and computed tomography.

This internal radiation therapy really allows doctors to target the tumour, eradicating any cancer cells from the area. While the tumour can receive a high dose of localised radiation, the healthy tissue will not be damaged.

Immunotherapy options

Immunotherapy is also an option for cervical cancer patients, as they respond well to the treatment due to the fact the cancer is caused by an infection.

It works by using the body’s immune system to destroy the cancer cells.

There have also been advancements in the development of a treatment that involves manipulating lymphocytes, which are immune cells that are found inside the tumour. By harvesting the lymphocytes and making them reproduce and multiply, scientists can then use them to attack the tumour by placing them back inside of it.

Signs of cervical cancer to look out for

Like any other type of cancer, the earlier cervical cancer is discovered, the better the prognosis is likely to be.

What’s more, if it is found as soon as possible, there are more options available with regards to treatment.

However, cervical cancer can be hard to discover, as it does not cause external lumps, such as with breast cancer.

Instead, it begins in the cells of the cervix. They then go through a process called dysplasia, turning them into abnormal cells, which then develop into cancer cells and spread further into the cervix tissue.

It is caused by long-lasted HPV infections, which can be transmitted through sex or skin-to-skin contact.

These days, older children can receive a vaccine to protect themselves from the HPV infection, which will reduce incidences of cervical cancer in the future. Although it is not usually given to people over the age of 26, it could be effective for some adults to avoid getting new HPV infections.

However, for those who have not received the jab, the only way to detect whether they have cervical cancer is through a Pap screening. This detects whether there are abnormal cells in the cervix that need further investigation.

They should also be on the lookout for common symptoms of cervical cancer, as they could flag these up with their doctor and request an earlier screening if they are concerned.

Signs of early stage cervical cancer include:

  • Bleeding after sex
  • Bleeding between periods
  • Heavier or longer periods than normal
  • Pain during sex
  • Pelvic pain
  • Bleeding after menopause
  • Vaginal discharge with a strong odour or containing blood

If the cancer has spread to other parts of the body, there are other signs to look out for. These include:

  • Lethargy
  • Abdominal pain
  • Painful bowel movements
  • Bleeding from the rectum when having a bowel movement
  • Blood in the urine or painful urination
  • Leg swelling
  • Dull backaches

Although these could also be caused by countless other conditions, if you are experiencing more than one or are concerned about the symptom, it is sensible to seek advice from a doctor as soon as possible.

If it turns out to be cervical cancer, it is best to start treatment, whether this includes chemotherapy followed by CRT, just a course of CRT, surgery, or immunotherapy, as soon as possible for the best results.

Your oncologist will be able to advise on the right course of action to take for your stage of cancer, age, and general health, so you have the greatest chances of surviving.