Radiotherapy to the oesophagus (gullet)

We have a number of staff who can help, as listed below. You will be assessed for a referral into these services. You may have already received care from similar services before coming to our hospital. If so, you should continue to follow any advice given by them. If you would like more information on the support services available to you, please talk to your therapeutic radiographer or nurse or visit our website. 

Our services include:

Upper GI Clinical Nurse Specialist

This member of staff is available to give additional information, advice and support to patients (and carers) who receive radiotherapy to their oesophagus.

Dietetic service

Difficulties with eating, reduced appetite and weight loss are common symptoms. However, eating as well as you can will help you to cope with and recover from the treatment. Our dieticians have written a leaflet 'Eating well and coping with side effects' which is available to you. It provides lots of information on how to make your food more nourishing rather than using nutritional products.

If you need further advice from a dietician, this can be arranged. If you are having a long course of radiotherapy, you are likely to be seen by our dietician at the hospital during your treatment. Those having a short course may be seen here or once at home in your GP’s surgery or local hospital.

You may already be using nutritional supplements, e.g. Ensure®. If not, they are frequently prescribed as part of your care. They are made by a number of companies and come in a variety of flavours - try different types if you don’t like the first ones you are prescribed. Many of the companies will have recipe ideas which are usually available from their websites.

In spite of support etc, weight loss is common during treatment and particularly so with a longer course. 

Nutrition Nurse Practitioner

The nutrition nurse practitioner works with the dieticians and others to ensure the care of patients who are considered nutritionally at risk and especially those who have a feeding tube.   

Specialised teams

If necessary, you can be referred to specialised teams for help, e.g. symptom control or psychological support.

Welfare benefits advisor

When you have been diagnosed with cancer, finances may not be the first thing you think about. Having cancer can be expensive because you may have unexpected costs, for example travel expenses, additional heating costs or childcare. You may not be able to work for a while and/or your partner may need to take time off work to care for you.  

You may be entitled to government benefits to help at this time. The Macmillan Benefits Advisor offers confidential and comprehensive benefits advice. If you would like an appointment, please ask for a member of staff looking after you to refer; you will then be contacted with an appointment.
 

Every patient is different and you may not have the same side effects as someone else. Your doctor will talk to you about the side effects that are likely to affect you. Most are temporary, but some may last for weeks or months after your treatment has finished (see later). Long term or permanent effects can occur but are fairly rare. Often these effects can be easily managed and may not have a marked effect on your life.

During your treatment, a therapeutic radiographer or nurse will be able to answer any questions and deal with most of your problems. However, your doctor can also see you if necessary. As you go through your treatment, how you feel and your ability to cope may change. It is important to let staff know how you feel so that we can give additional information, support, and medicines etc.

You will be reviewed during treatment and given medicines and advice to help you cope. If you are attending as an outpatient, occasionally admission to our wards may be offered and will be discussed as necessary.

Short-term effects (during and 4-6 weeks after treatment)

The usual pattern for the development of temporary (short term or acute) side effects is to gradually start 5-10 days after the first treatment. It is common for them to persist and worsen, the effects being the most troublesome about 10 days after the last radiotherapy treatment. After this, the healing process begins. The side effects usually settle over the following 2-3 weeks but are likely to be more troublesome and take longer to settle with a longer course of radiotherapy.

Difficulty swallowing

Most people experience this and the difficulty with swallowing may get worse before it improves. This is because the radiotherapy causes your oesophagus to become dry and sore. You may have some chest discomfort, especially when you swallow. Some people say that it feels like heartburn or back pain.    

You can help yourself by:

• Telling us if you have discomfort; you will be prescribed medicines to help. This often includes the use of pain relief medication
• Following the advice in the 'Eating well and coping with side effects' booklet. It includes information on how to make your food more nourishing and eating softer foods that are easy to swallow 
• Eating small meals and snacks often, even if you are not hungry
• Taking care when eating foods that are difficult to swallow unless chewed very well, e.g. meat
• Avoiding very hot spicy and sharp/tart foods and drinks or foods that may 'scratch' the oesophagus
• Drinking more fluid: 3-4 pints in addition to any tea or coffee you already take. Clear fluid is best, e.g. water or squash 
• Avoiding alcoholic drinks, especially spirits, until any discomfort has settled
• Telling us if you find food 'comes back up' after swallowing (regurgitation)
• Asking for medicines in liquid form if you have difficulty swallowing the tablets
• Preferably giving up smoking (or at least cut down). Advice and support to help you to do this, as well as nicotine replacement, is available from our specialist nurses and on-site pharmacy

If you have a stent (device in the oesophagus to keep it open), it is important to eat your normal foods, chop your food up into small pieces and chew your food well. Also have a drink, preferably after your meal. Doing so helps food to pass through the stent and helps to keep it clear after eating. If you have been given written information about what you can and can’t eat and drink, it would be useful to bring it with you for those providing your care here to see. 

Nausea and vomiting 

• Nausea sometimes happens 2-6 hours after treatment and usually settles within a couple of hours.
• Vomiting may happen without nausea, but it is more likely when you have nausea.

Let us know if this is happening.  Your doctor can prescribe anti-sickness tablets (anti-emetics) and tell you how to take them. Refer to our 'Eating well and coping with side effects' booklet for further information and advice.

Tiredness

It is quite common to feel weak and more tired than usual during, and for several weeks after, treatment. It is important to rest when you feel the need to do so. Ask your family and friends to help when they can. If you live alone, do only the things that are necessary until you recover. Planning ahead, doing only the things that are necessary and having plenty of rest breaks in your routine helps.

Ensure you eat as well as you can. 

Your skin and hair loss

Areas of skin around the chest area may become red, dry and itchy. The reaction is similar to mild sunburn. If your skin becomes uncomfortable, ask us for advice.  

Hair loss may occur in areas around your chest but it usually re-grows.

The lung 

Adequate treatment requires some radiation dose to lung tissue. However, we try to ensure that this dose is kept as low as possible. Temporary inflammation (soreness) of the lungs (called pneumonitis) can develop 1-3 months after finishing your radiotherapy.

The symptoms are a dry cough, an increase in shortness of breath and possibly a fever. Should these symptoms occur, please contact your GP or our triage help line. Treatment with steroids (rather than antibiotics) improves these symptoms.

You may experience some ongoing difficulties with swallowing because of scarring of the oesophagus, though it varies from person to person. 

If you notice this or it worsens, please tell your oncology doctor about this when you attend follow-up appointments as simple treatments to help are available. One such procedure stretches the oesophagus (dilation) and can be repeated on a few occasions, as required.

Some people find certain types of food, e.g. meat, cause difficulty. Often, changing the way they are eaten is helpful, e.g. ensuring food is soft when cooked, taken in small mouthfuls and chewed well.

Rarely, radiotherapy can cause scarring of lung tissue, which may cause shortness of breath. If this affects your daily activities, there are many simple ways of improving this. Please ask for advice from your GP or at follow-up appointments.

Rarely, a fistula (hole) between the gullet and airway can develop. This is serious and the sign for this is coughing soon after eating and/or drinking. In this event, you should preferably contact your GP, The Clatterbridge Cancer Centre Hotline or oncologist urgently for advice. If that is not possible, then you could go to the nearest A&E department.

Risk of damage to spinal cord; this is a rare complication.

As you complete your radiotherapy, your care needs will be assessed for additional support, i.e. district nurse teams. After treatment, your side effects will probably become more troublesome. This is usual and will settle over the next few weeks (see 'Short term effects of radiotherapy' section earlier).

Most people will be seen in an oncology clinic a few weeks after finishing radiotherapy treatment. This appointment is likely to be at your local hospital. If you have contact with other teams for ongoing supportive care, e.g. palliative care / Macmillan staff that visit you at home, consider contacting them and/or your GP if you have any concerns.

Otherwise, if you are unwell or have any urgent concerns, up to six weeks following your cancer treatment, you should contact The Clatterbridge Cancer Centre Hotline. After this time, you should contact your GP.

You can always ask to speak to or see your oncologist earlier than your scheduled appointment if you have any concerns or worries.

Macmillan booklets about coping and living with cancer and treatment side effects are available free of charge. These can be ordered by telephoning 0808 808 0000 or by visiting the Cancer Information and Support Centre (sited in the main entrances of Clatterbridge Cancer Centre - Liverpool, Clatterbridge Cancer Centre - Wirral and Clatterbridge Cancer Centre - Aintree).  

Some people and their carers find support groups are helpful; again contact the Cancer Information and Support Centre for details. 

Maggie's

Maggie's is a charity providing free cancer support and information to anybody who been affected by cancer.  Our cancer nurse specialists, psychologists and benefits advisors are here to support you during treatment or after your treatment has finished.    

The Maggie's Centres allow you to share experiences with others in a similar situation around our kitchen table. We provide courses on survivorship, bereavement, stress management, mindfulness, tai chi, yoga, relaxation or cancer support groups. You do not need an appointment or a referral to access any support from Maggie's - you can just drop in.  Our telephone number is 0151 334 4301.  

Alternatively, if you are familiar with using the internet, the major cancer charities often have on-line communities.

Clatterbridge Cancer Centre - Liverpool  

65 Pembroke Place, Liverpool, L7 8YA 
Tel: 0151 556 5000  
www.clatterbridgecc.nhs.uk 

Clatterbridge Cancer Centre - Wirral 

Clatterbridge Road, Bebington, Wirral, CH63 4JY 
Tel: 0151 556 5000  
www.clatterbridgecc.nhs.uk 

Clatterbridge Cancer Centre - Aintree 

Lower Lane, Fazakerley, Liverpool, L9 7AL 
Tel: 0151 556 5959  
www.clatterbridgecc.nhs.uk 

Macmillan Cancer Support

Tel: 0808 808 0000
www.macmillan.org.uk

Cancer Information and Support Centre:

Clatterbridge Cancer Centre – Liverpool. Tel: 0151 318 8805