What happens during radiotherapy 

Deciding to have treatment

If you're diagnosed with cancer, you'll be cared for by a team of specialists. Your team will recommend radiotherapy if they think it's the best option for you, but the final decision is yours.

Making this decision can be difficult. You may find it useful to write a list of questions to ask your care team.

For example, you may want to find out:

• what the aim of treatment is – for example, is it being used to cure your cancer, relieve your symptoms or make other treatments more effective?
• about possible side effects and what can be done to prevent or relieve them
• how effective radiotherapy is likely to be
• whether any other treatments could be tried instead

If you agree with your team's recommendation, they'll start to plan your treatment once you've given your consent to treatment.

Planning your treatment

Your treatment will be carefully planned to ensure the highest possible dose is delivered to the cancer, while avoiding damage to nearby healthy cells as much as possible.

You will probably have a computerised tomography (CT) scan to work out exactly where your cancer is and how big it is.

After the scan, some very small but permanent ink marks may be made on your skin to ensure the right area is targeted accurately each time.

If you're having radiotherapy to your head or neck, a plastic mask will be made for you to wear during treatment. The ink marks will be made on the mask.

Your treatment course

Radiotherapy is usually given as a number of treatments where a small dose of radiation is given daily over several weeks.

Before treatment starts, your care team will draw up a plan that outlines:

• the type of radiotherapy you'll have
• how many treatment sessions you'll need
• how often you'll need treatment

Most people have five treatments a week (one treatment a day from Monday to Friday, with a break at the weekend). But sometimes treatment may be given more than once a day or over the weekend.

Your doctor may call each dose a "fraction", although the term "attendance" is sometimes used to indicate how many hospitals visits you'll need to make during treatment.

Want to know more?

• Cancer Research UK: planning external radiotherapy
• Macmillan: planning your radiotherapy treatment

Radiotherapy is usually given in one of two ways:

• external radiotherapy – where a machine directs beams of radiation at the cancer
• internal radiotherapy – where a radioactive implant is placed inside your body near the cancer, or a radioactive liquid is swallowed or injected

The main types of radiotherapy are outlined below.

Radiotherapy given using a machine (external radiotherapy)

During external radiotherapy, you lie down on a table and a machine is used to direct beams of radiation at the cancer.

The machine is operated from outside the room, but you'll be watched through a window or a camera. There will be an intercom if you need to speak to the person treating you.

You need to keep as still as possible throughout the treatment. It usually only takes a few minutes and is completely painless. You can normally go home soon after it has finished.

Sometimes a slightly different technique may be used, such as:

• intensity-modulated radiation therapy (IMRT) – where the shape and strength of the radiation beams are varied to closely fit the area of the cancer
• image-guided radiation therapy (IGRT) – where scans are done before and during each treatment session to ensure the cancer is targeted accurately
• stereotactic radiosurgery (SRS) – where lots of tiny beams of radiation are aimed at the cancer very precisely, so a high dose can be given at once (usually in a single treatment)
• stereotactic body radiation therapy (SBRT) – where several beams of radiation are directed at the cancer from several directions

You can ask your doctor about the technique being used for your treatment.

Radiotherapy implants (brachytherapy)

Radioactive implants (metal wires, seeds or tubes) may be used to treat cancer in areas of the body where they can be placed inside the body without surgery (such as the vagina).

Sometimes surgery is used to place an implant near the cancer.

The length of time the implant is left in your body varies. It could be a few minutes or a few days. In some cases, tiny implants may be left inside the body permanently.

The radiation from the implants is painless, but it could be harmful to others so you may need to stay in hospital for a few days until the implant is removed.

Permanent implants aren't a risk to others because they produce a very small amount of radiation that gradually decreases over time.

Radiotherapy injections, capsules or drinks (radioisotope therapy)

Some types of cancer, including thyroid cancer and some prostate cancers, can be treated with radioactive liquid that's swallowed or injected.

You may be radioactive for a few days after treatment is given, so you'll probably need to stay in hospital as a precaution until the amount of radiation has fallen to a safe level.

Your treatment team may give you some advice to follow for a few days when you get home to avoid putting other people at risk.

Want to know more?

• Cancer Research UK: external radiotherapy
• Cancer Research UK: internal radiotherapy
• Macmillan: external beam radiotherapy explained
• Macmillan: internal radiotherapy explained

During radiotherapy treatment, there are a number of important things to bear in mind.

Pregnancy and contraception

Women should avoid becoming pregnant while having radiotherapy, as the treatment could harm your baby.

Use an effective method of contraception, such as a condom, and contact your care team immediately if you think you may be pregnant.

Men having radiotherapy may sometimes be advised to use contraception during treatment and possibly for several months afterwards.

Macmillan has more information about sex life and radiotherapy.

Side effects

Radiotherapy can cause a range of side effects.

Read about the side effects of radiotherapy.

Deciding to stop treatment

Some people decide that the benefits of radiotherapy aren't worth the poor quality of life, due to the side effects.

If you're struggling with the treatment and are having doubts about whether to continue, it's a good idea to speak to your care team.

Your team can give you advice about the likely benefits of continuing with treatment, but the final decision to continue or stop is yours.