Having radiotherapy treatment for anal cancer
External radiotherapy uses high energy waves similar to x-rays to destroy cancer cells.
You have radiotherapy in a hospital radiotherapy department. You go to the radiotherapy department from your ward if you’re already in hospital.
When you might have it
You might have radiotherapy:
- combined with chemotherapy (chemoradiotherapy)
- to relieve symptoms of anal cancer that has spread (advanced anal cancer)
Chemoradiotherapy
Chemotherapy combined with radiotherapy (chemoradiotherapy) is the main treatment for anal cancer that hasn't spread to other parts of the body.
Doctors know from research that this is a better treatment for anal cancer than surgery. If chemoradiotherapy is successful, you won't need a permanent colostomy.
You usually have radiotherapy for 5 days per week over 5 weeks.
For cancer that has spread
Radiotherapy can relieve the symptoms of advanced anal cancer, such as pain. It aims to shrink or control the growth of the cancer for a period of time. This is called palliative radiotherapy.
Type of radiotherapy
You have intensity-modulated radiotherapy (IMRT) for anal cancer. IMRT is a type of conformal radiotherapy. Conformal radiotherapy shapes the radiation beams to closely fit the area of cancer.
You can have IMRT on a standard radiotherapy machine, called a linear accelerator (LINAC).
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 it might 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 treatment
You usually get a bowel and bladder prep sheet a few weeks before your scan. This explains how you can help prepare your bladder and bowels for the planning scan and treatment. Following this advice can help reduce long term side effects to your bladder and bowels.
Your radiographer will explain how to prep your bladder and bowels. They will check you have emptied your bowels that day and ask you to empty your bladder. They will then explain how you can fill your bladder by drinking water. You will have to also do this before every treatment.
If your bladder is not full enough, or your bowels aren't empty enough, the scan may need to be repeated.
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.
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 line sup with certain things on your body uh so no, no real noise and no discomfort.
You won't be radioactive
This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.
Travelling to radiotherapy appointments
You might have to travel a long way each day for your radiotherapy. This depends on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.
You can ask the for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7 am till 9 pm.
Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or discounted parking. They may be able to give you tips on free places to park nearby.
Hospital transport may be available if you have no other way to get to the hospital. But it might not always be at convenient times. It is usually for people who struggle to use public transport or have any other illnesses or disabilities. You might need to arrange hospital transport yourself.
Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this and hospital transport.
Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.
Side effects of treatment
Side effects of radiotherapy for anal cancer can include feeling tired, sore skin around the anus and groin, or bladder irritation. You may also need to open your bowels frequently, or may feel sick.
