Radiotherapy for bile duct cancer
Radiotherapy uses high energy x-rays to treat cancer cells. For bile duct cancer, you usually have external radiotherapy. This means using a radiotherapy machine to aim radiation beams at the cancer.
You have this treatment in the hospital radiotherapy department. It doesn't hurt, although laying on the radiotherapy couch can be uncomfortable.
When you might have radiotherapy for bile duct cancer
Radiotherapy isn't a common treatment for bile duct cancer. You might have it if you can't have surgery. Or to help control symptoms caused by bile duct cancer spread. This is called palliative treatment.
Radiotherapy to help control symptoms
Your doctor might suggest that you have radiotherapy to help control symptoms such as pain. Radiotherapy can help to shrink the cancer and make you feel better.
You might have 1 treatment or a few treatments given over a few days. These treatments are sometimes known as fractions.
Types of radiotherapy for bile duct cancer
You usually have external radiotherapy. This means that a radiotherapy machine aims the radiation beams at the cancer.
There are different types of external radiotherapy. Your doctor decides which is best for you.
You are most likely to have conformal radiotherapy or intensity modulated radiotherapy (IMRT). These shape the radiation beams to closely fit the area of the cancer.
Stereotactic body radiation therapy (SBRT)
Researchers are looking into a type of radiotherapy called stereotactic body radiation therapy (SBRT). This gives radiotherapy from many different positions around the body. The cancer receives high doses of radiation but the surrounding tissues only get a low dose. This lowers the risk of side effects.
Your doctor might ask you to enter a clinical trial looking at SBRT for bile duct cancer.
Selective Internal Radiation Therapy (SIRT)
Selective internal radiation therapy is a type of internal radiotherapy. It is sometimes called radioembolisation or trans arterial radioembolisation (TARE).
SIRT is a way of giving radiotherapy treatment to the liver. Your doctor puts tiny radioactive beads into a blood vessel that takes blood into your liver. The beads get stuck in the small blood vessels in and around the cancer, and the radiation destroys the cancer cells.
SIRT isn't routinely used for people with bile duct cancer in the UK. Your doctor may be able to make a special application if they think this can help you or ask you to join a clinical trial.
Planning your radiotherapy treatment
You have a planning session with your radiotherapy team a few days before you start treatment. This means working out the dose of radiotherapy you need and exactly where you need it.
Your planning appointment takes from 15 minutes to 2 hours.
You usually have a planning CT scan in the radiotherapy department.
The scan shows the cancer and the area around it. You might have other types of scans or x-rays to help your treatment team plan your radiotherapy. The plan they create is just for you.
Your radiographers tell you what is going to happen. They help you into position on the scan couch. You might have a type of firm cushion called a vacbag to help you keep still.
The CT scanner couch is the same type of bed that you lie on for your treatment sessions. You need to lie very still. Tell your radiographers if you aren't comfortable.
Injection of dye
You might need an injection of contrast into a vein in your hand. This is a dye that helps body tissues show up more clearly on the scan.
Before you have the contrast, your radiographer asks you about any medical conditions or allergies. Some people are allergic to the contrast.
Having the scan
Once you are in position your radiographers put some markers on your skin. They move the couch up and through the scanner. They then leave the room and the scan starts.
The scan takes about 5 minutes. You won't feel anything. Your radiographers can see and hear you from the CT control area where they operate the scanner.
Ink and tattoo marks
The radiographers make pin point sized tattoo marks on your skin. They use these marks to line you up into the same position every day. The tattoos make sure they treat exactly the same area for all of your treatments. They may also draw marks around the tattoos with a permanent ink pen, so that they are clear to see when the lights are low.
The radiotherapy staff tell you how to look after the markings. The pen marks might start to rub off in time, but the tattoos won’t. Tell your radiographer if that happens. Don't try to redraw them yourself.
After your planning session
You might have to wait a few days before you start treatment. During this time the physicists and your radiographer doctor (clinical oncologist) decide the final details of your radiotherapy plan. They make sure that the area of the cancer will receive a high dose and nearby areas receive a low dose. This reduces the side effects you might get during and after treatment.
The radiotherapy room
Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine might be fixed in one position or able to rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.
Before your first treatment, your 
will explain what you will see and hear. In some departments the treatment rooms have docks for you to plug in music players. So you can listen to your own music while you have treatment.
Before each treatment session
The radiographers help you to get onto the treatment couch. You might need to raise your arms over your head.
The radiographers line up the radiotherapy machine using the marks on your body. Once you are in the right position, they leave the room.
During the treatment
You need to lie very still. Your radiographers might take images (x-rays or scans) before your treatment to make sure that you're in the right position. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.
Your radiographers can see and hear you on a CCTV screen in the next room. They can talk to you over an intercom and might ask you to hold your breath or take shallow breaths at times. You can also talk to them through the intercom or raise your hand if you need to stop or if you're uncomfortable.
The short video below shows how you have radiotherapy:
Dan (radiographer): Before your treatment starts your doctor will need to work out exactly where the treatment needs to go and also which parts need to be avoided by the treatment. To have radiotherapy you lie in the same position as you did for your planning scans. We then line up the machine based on your tattoo marks. It is really important that you stay very, very still when you are having treatment it is also important to let the radiographers know right at the beginning if you are not comfortable so they can adjust your position.
Radiographer: Ok all done, we’ll be back in a couple of minutes.
Dan (radiographer): We leave the room and control the room from a separate room This is so we aren’t exposed to radiation. Treatment takes a few minutes and you will be able to talk to us using an intercom. We can see and hear you while you are having your treatment and will check that you are ok. When your treatment starts you won’t feel anything; you may hear the machine as it moves around you giving the treatment from different angles. Because we are aiming to give the same treatment to the same part of the body everyday then the treatment process is exactly the same everyday so you shouldn’t notice any difference. You’ll see someone from the team caring for you once a week while you are having treatment they’ll ask how you are and about any side effects.
Patient: They get you from one sitting area to another and then take you into the room where you undress to the waist and then lie down and line you up by either moving you or asking you to shuffle a little and they check the dimensions and they talk to one another and they say I am fine this side how are you ...yes fine...ok, stay where you are Jeff and that was it. There were a few little clicks and lights go on and off and you can see a green laser beam which lines up with certain things on your body uh so no, no real noise and no discomfort.
You won't be radioactive
External radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.
Side effects of radiotherapy
For bile duct cancer, you usually have a short course of radiotherapy treatment of only a few days, so you might have very few side effects. You are likely to have more side effects if you have treatment for a couple of weeks.
Side effects tend to start a week after the radiotherapy begins. They gradually get worse during the treatment and for a couple of weeks after the treatment ends. But they usually begin to improve after around 2 weeks or so.
Tiredness and weakness
You might feel tired during your treatment. It tends to get worse as the treatment goes on.
Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. It's important to balance exercise with resting.
Feeling or being sick
You might feel sick at times. Let your treatment team know if you feel sick, as they can give you anti sickness medicines.
Reddening or darkening of your skin
Your skin might go red or darker in the treatment area. You might also get slight redness or darkening on the other side of your body. This is where the radiotherapy beams leave the body.
Diarrhoea
Radiotherapy to the tummy (abdomen) can cause diarrhoea. Drink plenty of fluids and let your doctor know if you have frequent diarrhoea.
