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.

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.

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.

In what oncologists described as possibly the biggest breakthrough in cervical cancer treatment in two decades, a course of chemotherapy before radiotherapy is projected to dramatically improve the success rates of cancer treatment.

This is according to the results of the GCIG INTERLACE trial, a phase III clinical trial of 500 patients with cervical cancer who were set to undergo chemoradiation, a combination treatment for radiotherapy and chemotherapy which is more effective together than each treatment is on its own.

Half of them received a six-week course of Taxol/Carbo, a combination chemotherapy treatment used to treat lung, ovarian and cervical cancer, before their standard course of treatment.

The other half only received this standard course of treatment, which consisted of cisplatin, brachytherapy radiotherapy and conventional radiotherapy treatments for cervical cancer every week.

The group that received the short course of chemotherapy found that the rate of return for cancer after the treatment after five years was 35 per cent less in the pre-radiotherapy chemotherapy group compared to the control group, the biggest improvement in outcomes seen in over 20 years.

The biggest benefit besides the improved survival rates is that Taxol/Carbo is already approved for chemotherapy, is widely used, accessible and inexpensive, meaning that it can be added to a standard course of treatment quickly.

However, as with most cancer treatments, not every case is the same and therefore not every cervical cancer patient will be suitable for this treatment.

The study was primarily on women in the early stages of cancer before it had started to spread, and it is not known how effective it would be for more advanced cervical cancer cases, although improved screening and diagnosis are helping to offset this by getting people treated sooner.

An extra course of chemotherapy also has the typical side effects of chemotherapy, such as nausea, sickness and damage to the hair.

However, more options for treatment are always beneficial to patients, as it increases the chance of finding the most suitable one for a given case.

Cancer is a relentless adversary, but the battle against it can vary significantly depending on whether it’s primary or secondary cancer. Understanding these distinctions is vital for patients and their families, especially when it comes to the role of radiotherapy in the treatment plan.

Primary Cancer: The Initial Encounter

Primary cancer is where the disease originates. It begins in a particular organ or tissue, often leading to a localised tumour. The management of primary cancer typically involves a combination of treatments, which may include surgery, chemotherapy, immunotherapy and radiotherapy.

When it is employed for primary cancer, the goal is often to target the tumour directly while minimising damage to surrounding healthy tissue. The treatment plan is customised for each patient, taking into account the tumour’s location, size and type.

Secondary Cancer: The Challenge of Metastasis

Secondary cancer, on the other hand, results from the spread of cancer cells from the primary site to other parts of the body. These metastatic tumours can be located in distant organs or tissues, making treatment more complex.

Radiotherapy for secondary cancer aims to target and control the metastatic tumours while also considering the potential risks to the patient’s overall health. The approach is often more palliative, focusing on symptom relief, pain management and improving the patient’s quality of life.

Differences In Radiotherapy Approaches

The main difference between primary and secondary cancer radiotherapy lies in the intent and scope of treatment. Primary cancer therapy is typically curative, aiming to eradicate the tumour. In contrast, secondary cancer therapy is usually palliative, focusing on symptom control and extending life while maintaining a good quality of life.

What To Expect

For both primary and secondary cancer therapy, patients can expect a thorough evaluation and treatment planning process. Imaging scans, such as CT or MRI, help determine the precise location and size of the tumours. The treatment team will work together to create a customised plan that balances the treatment’s effectiveness with minimising side effects.

Side-effects can include fatigue, skin irritation and discomfort, depending on the treatment site. Patients are closely monitored throughout the treatment course, and adjustments are made as needed to manage side effects and ensure the best possible outcome.

In conclusion, while the specifics may differ for primary and secondary cancer, the overarching goal remains the same: to provide patients with the best possible care and treatment. The choice of as part of the treatment plan depends on the individual circumstances of the patient and the expertise of the medical team.