Treatment with chemotherapy and radiotherapy is called chemoradiotherapy.
You might have chemoradiotherapy if your cancer has spread into surrounding tissues or lymph nodes. Rarely, it is used for small early mouth cancers (if you cannot have surgery). This is not suitable for everyone. your doctor will discuss your treatment plan with you.
You might have chemoradiotherapy after surgery if there is a high risk of your cancer coming back.
How does chemoradiotherapy work?
Chemotherapy drugs can make cells more sensitive to radiotherapy. This helps radiotherapy to kill cancer cells. Researchers have found that chemoradiotherapy works better than radiotherapy alone for some people with mouth and oropharyngeal cancer.
How you have it
Your exact treatment plan depends on your situation.
Your radiotherapy might last for about 7 weeks. Your chemotherapy will be every 3 to 4 weeks or perhaps weekly.
Chemoradiotherapy can be quite a tough treatment. It can cause damage to some healthy cells at the same time. This might cause side effects. You will need some tests to check you are well enough to cope with it.
After chemoradiotherapy, if there are still signs of cancer, you might have surgery to remove it. If the cancer comes back in the future, you might be able to have surgery to remove it then.
You usually have treatment in the chemotherapy day unit or you might need to stay in hospital for a day or more.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris, my name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment, you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having, we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods, so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot, so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse, who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room. You’ll have a blood test and an examination to make sure you are fit and well for treatment. You will then come back the following day or later on that week for treatment.
Before you begin treatment, the radiotherapy team works out how much radiation you need. They divide it into a number of smaller treatments. They call each treatment a fraction. This is called radiotherapy planning.
Daniel (senior 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's really important that you stay very very still when you're having your treatment. It’s also important to let the radiographers know right at the beginning if you're not comfortable, so they can adjust your position”.
(Radiographer): “Ok, all done we'll be back in a couple of minutes”.
(Daniel): “We leave the room and control the machine from a separate room. This is so we aren't exposed to radiation.
Treatment takes a few minutes and you'll be able to talk to us using an intercom.
We can see and hear you while you're having your treatment and will check that you're 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're aiming to give the same treatment to the same part of the body every day then the treatment process is exactly the same everyday. So you shouldn't really notice any difference.
You'll see someone from the team caring for you once a week while you're having treatment.
They'll ask how you are and ask about any side effects”.
Jeff (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'm fine this side, how are you?
Yes fine, ok, stay where you are Jeff, and that was it.
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….so no, no real noise and no discomfort”.
It is likely that you will have some side effects from your treatment. You can read about chemotherapy and radiotherapy side effects at the links below. But when you have both treatments together some of the side effects can be more severe.
In particular, you are likely to get a very sore mouth and throat. For some people, the mouth is so sore that swallowing is very difficult. You might need a feeding tube so that you can get enough liquid and calories.
You will also have painkillers. If needed, you can have a strong painkiller, such as morphine, to help make your mouth more comfortable.
When you have a very sore mouth and throat, it is important to be careful about infection. Try to keep your mouth clean and follow the advice of your nurse and dentist. Contact the hospital at the first sign of infection, particularly a high temperature with chills, a sore chest, or a cough. It is likely that you will need to go to the hospital and have antibiotics through a drip.