This page has been written for patients who are receiving radiotherapy to the chest for a tumour of the lung, oesophagus, or lymphoma. It describes the side-effects you may experience during and after treatment, and how best to cope with them.
We understand this is a worrying time for patients and their families, and we hope this page can help to answer any questions you have. If you have any questions about the treatment or information on this page, please speak to the team looking after you.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law, we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to having the procedure and understand what it involves.
Staff will explain all of the risks, benefits and possible alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak to the team looking after you.
During your time with us we aim to provide the highest standards of care and support you in your decisions regarding your treatment. We will respect your dignity, individuality and personal preferences.
Your care will be managed and given by therapeutic radiographers, doctors and nurses. You will meet both male and female healthcare professionals during the course of your treatment. If you have any concerns about this, please talk to the radiographers about it. We try to be sensitive to your needs, so please do not hesitate to discuss things with the team caring for you.
If you are of an age where you can get pregnant (12 to 55 years old) and capable of becoming pregnant (you have a womb), you will be asked to confirm that you are not pregnant. You must tell the staff immediately if there is any chance of you being pregnant at any time during your treatment. You should not become pregnant for at least four months after radiotherapy.
If you can conceive a child (you have testes), you should not conceive a child for at least four months after radiotherapy treatment. All patients should use reliable contraception throughout this period. If you have any further questions or concerns, please talk to your radiotherapy doctor, specialist nurse or specialist radiographer involved in your care.
Radiotherapy appointments:
All take place in the Radiotherapy Department, basement floor, main UCH hospital building.
Proton beam therapy appointments:
All take place in the Proton Beam Therapy Department, floors B3 and B4, Grafton Way Building.
Radiotherapy is the specialised treatment of cancer (and some other diseases) using high energy radiation beams. These can either be photons (also called x-rays), electrons or protons. Photons and electrons are delivered from a machine called a linear accelerator whilst protons are delivered from a machine called a cyclotron.
University College Hospital Trust is one of two NHS proton beam therapy (PBT) centres in the UK, alongside The Christie in Manchester. Proton beam therapy is an advanced form of radiotherapy. However, it is not appropriate to treat all tumours with proton beam therapy. The most appropriate treatment for you will be decided by their clinical oncologist and discussed with you.
Radiotherapy works by damaging cancer or tumour cells in the part of the body being treated. The radiation stops the cells from dividing and growing. Radiotherapy can also damage nearby normal cells. The normal cells are more likely to recover from the effects of the radiation than the cancer or tumour cells. The clinical team take great care to reduce the radiation dose to a person’s healthy cells.
Radiotherapy does not hurt, and it will not make you radioactive. You will be completely safe to be around family, friends and pregnant women. You will feel nothing from the treatment and the machine will not touch you. It is rather like having an ordinary X-ray. The most important thing is for you to lie very still for treatment.
Patients will normally receive their treatment as an outpatient. Treatments are given daily, Monday to Friday, with no treatments at the weekend. A course of treatment can last up to six and a half weeks. Your treatment schedule will be decided by your doctor and confirmed on your first treatment visit to the radiotherapy or proton beam therapy department.
Although you will not feel anything during treatment, there will be some side effects which will gradually appear during your course of radiotherapy. These effects will vary from patient to patient. There are side effects occurring during treatment, some happening soon after treatment, and some appearing months or years after radiotherapy.
The risk and severity of side effects occurring will depend on the dose of radiotherapy given and the exact area which receives the radiotherapy. Your doctor will discuss the risks of treatment with you before you sign a consent form. However, there will still be plenty of opportunity to talk about anything that you feel needs further discussion.
Skin changes
The skin in the area being treated will gradually change colour. Your skin will gradually become pink/red or darker, depending on your skin colour. You may get some dry peeling of the skin in the treatment area, which may become itchy.
This is a normal reaction to the radiotherapy. Your skin reaction will be monitored daily by the radiographers who will advise you.
During treatment, we recommend that you wash using warm water and the soap products you would normally use. Gently pat your skin dry with a soft towel.
Radiotherapy skin reactions cannot be prevented, but to minimise any skin irritation we recommend using a moisturiser. If you do not currently use a moisturiser, then speak with your radiotherapy team and they will be able to suggest some options for you. Use the moisturiser frequently and gently smooth it on to your skin until it is absorbed. You do not need to wipe the moisturiser off before treatment, but please do not apply moisturiser immediately before treatment.
If your skin becomes irritated stop using the moisturiser. You will be referred to the radiotherapy review team for appropriate skin care.
Avoid rubbing or scratching the skin in the treatment area. Avoid exposing the skin in the treatment area to strong sunlight or extreme temperature changes during and after treatment. The skin in the treatment area is always going to be more sensitive to the sun, so it needs to be protected with clothing and a high factor sun cream.
Cough
You may notice an increase in a dry or productive cough, and you may experience flu-like symptoms. This is due to the radiotherapy causing inflammation, but this reaction should subside as you progress through treatment. If the cough is persistent or you have any concerns, talk to the treatment radiographers or nurses who can refer you to the doctor.
You may also notice blood in any phlegm/sputum that you produce. Please inform the radiographers if you notice this. The bleeding may be related to the disease or to the effects of the radiation, but again, it should resolve.
Chest pain
You may develop pain or aches in the area being treated. This is due to the radiotherapy causing inflammation of the tissues. Some patients may already have pain due to the disease and the radiotherapy may temporarily worsen these symptoms. You may have been prescribed painkillers already by the doctor. If not, and the pain is troubling you, please speak to the radiographers or nurses. They can arrange for the doctor to prescribe medication.
Breathlessness
The symptoms of breathlessness will vary depending on the dose of radiotherapy received and the number of treatments. Patients receiving palliative (a short course) radiotherapy may already be experiencing breathlessness before radiotherapy begins. As treatment commences you may find the shortness of breath increasing. This is initially due to the radiotherapy and should resolve within 24 to 48 hours.
If you experience such symptoms, rest as much as possible and try not to undertake any unnecessary strenuous tasks. If you are using portable oxygen to aid your breathing, you may find that you will need to increase this until the side effects of the radiotherapy disappear. Symptoms of breathlessness can be distressing and cause anxiety. Contact your specialist nurse if you require help.
Patients receiving radical (a long course) radiotherapy may develop symptoms of breathlessness towards the end of treatment.
More importantly, there may be a recurrence or the first appearance of breathlessness some weeks after radiotherapy has finished. This is due to a condition called sub-acute pneumonitis, which is a side effect of the radiotherapy, and there may be an increase in a dry cough. This should get better on its own within a few weeks. Some patients, however, may require a short course of steroid tablets. If you are worried, or if the side effects continue for longer, please contact your consultant, specialist nurse or GP.
Eating and swallowing
During your radiotherapy treatment, you are advised to maintain a healthy, well-balanced diet as far as possible. However, while having treatment you may experience a loss of appetite, indigestion/heartburn and difficulty in swallowing.
These are all common side effects of radiotherapy. If you do not feel like eating, try small regular snacks and supplement these meals with high calorie drinks, which can be bought from the chemist, given by the oncology dietitian or prescribed by your GP.
The radiographers will also give you advice on nutrition or refer you to the oncology dietitian who can offer advice on maintaining a nourishing and pleasant diet. Eat slowly and drink plenty of fluids to aid digestion. If you are experiencing indigestion/heartburn, try to avoid very hot or very cold food and drinks. Eat food that is easy to chew and swallow. Try not to eat rich, spicy foods and avoid neat alcoholic spirit drinks. If you are experiencing any discomfort when eating, please inform the radiographers or nurses. They can provide appropriate advice or refer you to the doctor for medication to relieve any discomfort.
Feeling sick (nausea)
You may feel sick, particularly if the treatment area is near the stomach, and sometimes be sick. Please inform the radiographers if this happens. The doctor can prescribe anti-sickness tablets to help alleviate any symptoms. If you are feeling nauseous you may not feel like eating, so you can be referred to the dietician who can offer advice.
Hair loss
There may be a temporary loss of chest hair (in male patients) in the area being treated. This is a normal reaction. The hair usually grows back within a few months once the treatment is over. However, sometimes hair loss may be permanent, depending on the dose of radiotherapy given.
Hoarse voice
You may also experience hoarseness (a gruff sounding voice), particularly if the treatment area includes the throat. Again, this is a normal reaction and is caused by the radiotherapy causing inflammation of the vocal cords. If your throat becomes sore, please tell the radiographers who will advise you accordingly.
Fatigue
Fatigue is a very common side effect of radiotherapy. You may feel more tired than usual and have less energy, both during and after treatment. Do not worry, this is normal. It is usually a combination of travelling to hospital every day, the side effects of treatment, coping with a diagnosis of cancer and continuing with normal life.
We recommend that you listen to your body. Do as much as you feel you can and rest when you need to. However, gentle exercise has been found to improve fatigue levels in patients and we would recommend walking as a good form of exercise.
Please let someone know if you are finding things difficult, as they may be able to offer practical advice.
At your first treatment appointment the radiographers will discuss the treatment with you and explain any possible side effects you may experience. They will see you every day and ask how you are and how you are feeling.
During treatment you will be assessed regularly by the lung specialist radiographer who will monitor your side effects and review your progress.
It is recommended that you should stop smoking not only during your radiotherapy treatment, but altogether. Continuing to smoke during treatment will worsen any side effects you may experience and may decrease the effectiveness of treatment. Your specialist lung radiographer or lung clinical nurse specialist will be able to offer practical support if you wish to stop smoking.
This page deals with the physical aspects of your treatment, but your emotional wellbeing and that of your family is just as important.
Having treatment can be deeply distressing for some patients. Within the radiotherapy department there will be access and support from your specialist nurse, the Macmillan information and support radiographer, Macmillan radiotherapy support workers, the treatment radiographers and the radiotherapy review team. However, if you feel you require further medical or emotional support you can be referred to a variety of health professionals who can help with any worries or difficulties you may be having.
All the staff are here to make sure your treatment goes as smoothly as possible and to support you through this difficult period. We will try to help you with any questions or problems you may have.
Once your radiotherapy treatment has finished, you will receive a follow-up appointment to see the radiotherapy doctors in four to six weeks’ time. This will either be at University College London Hospital or your referring hospital.
The side effects you will have experienced will continue after radiotherapy treatment has finished. It is common to experience a worsening of the skin reactions for about 10 to 14 days after radiotherapy. Please feel free to contact the department or your specialist nurse. You could also contact your GP or call the outpatients to request an earlier follow-up appointment.
If you have been provided with a physical copy of this page, please fill in your Key worker's details below.
My key worker is:
They can be contacted on:
Lung Specialist Radiographer
Radiotherapy Review Team (Via Radiotherapy reception)
Proton Beam Therapy Review Team (via Proton Beam Therapy Reception)
Radiotherapy reception
Proton Beam Therapy Reception
Macmillan Information and Support Radiographer
Out of hours oncology advice number (available 24 hours)
If you have any concerns that you would like to discuss in confidence, please contact our PALS (Patient Advice and Liaison Service) for information and advice.
Roy Castle Lung Cancer Foundation
UCLH cannot accept responsibility for information provided by other organisations.
Services
Page last updated: 24 September 2024
Review due: 01 February 2026