Radiotherapy - head and neck cancer team radiotherapy for head and neck cancers

Radiotherapy has been recommended as part of your treatment plan. This guide answers the questions our patients ask most often. The Head and Neck Oncology team will discuss your treatment options with you fully; use this leaflet alongside that conversation, not instead of it.

If you need to see your GP, practice nurse or district nurse about radiotherapy or chemo-radiotherapy side effects, please take this leaflet with you.

Useful Contacts

Contact; when you call the hospital and attend appointments is it useful to have your hospital number to hand.

My hospital number. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

My consultant oncologist is. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Jo Gemmill, Advanced Practice Radiographer (Head and Neck) - Works Monday, Wednesday, Thursday 01223 596330

Diana Domingues Specialist Radiographer (Head and Neck) – Full time with alternative Fridays off 01223 596330

This is a confidential answerphone for radiotherapy/chemo-radiotherapy queries.

Radiotherapy reception (for appointment queries) 01223 216634

Acute Oncology Service (24 hours) — for use if you're unwell during or after treatment 01223 274224

What is radiotherapy?

Radiotherapy is the use of high energy x-rays to treat cancer (malignant) and some benign (non-cancerous) tumours. It works by damaging cells within the area of treatment. Although the area treated with radiotherapy is tailored as much as possible to target only the tumour cells, some normal tissue will be within the treatment area and they are also affected by the radiotherapy.

Virtual Timeline of Radiography (opens in a new tab)

Where do I go for radiotherapy appointments?

Radiotherapy is planned and delivered in the radiotherapy department, which is part of the oncology department at Addenbrooke’s hospital, located on level 2 in outpatients. Treatments are usually delivered as daily outpatient appointments from Monday to Friday, occasionally Saturdays or in some circumstances you may have two treatments on one day scheduled.

Your oncology team will decide how many treatments are most appropriate for you. Treatment regimens vary according to individual needs.

How is radiotherapy treatment given?

The treatment machine used to deliver radiotherapy is called a Linear Accelerator ('Linac' or 'LA') or Tomotherapy unit ('Tomo'). These treatment machines direct high-energy radiotherapy beams over a carefully planned area of treatment. In order to deliver treatment patients are carefully positioned. You will be asked to lie flat on a treatment couch, which is similar to a CT (computed tomography) scanner couch, in the radiotherapy room. Although the treatment machines can be noisy the radiotherapy beams cannot be seen and the procedure itself is painless, much like having an x-ray or CT scan. Radiotherapy can be given conventionally or with image guided intensity modulated radiotherapy (IG IMRT). The team will decide which is most appropriate for your treatment.

Radiotherapy is planned and delivered by male and female radiotherapy radiographers.

How long will I be in the Radiotherapy Department?

Please allow the following amounts of time for each type of appointment:

• Planning appointment: at least two hours
• Pre-treatment or post-treatment appointments: usually done by phone, but let us know if you'd prefer to come in person
• Radiotherapy treatment appointments: at least one hour
• Review clinic days: at least two hours (you'll have radiotherapy treatment and be seen by the head and neck team in clinic, these clinics run alongside your treatment appointment and will show on your treatment schedule)

Please note:

• The Outpatient Pharmacy is very busy, so please let the head and neck team know in clinic if you're running low on medications to avoid running out.
• Allow extra time if you think you may need a prescription, and extra time again to collect it.
• Please continue to get any routine prescriptions from your GP. If swallowing tablets becomes difficult, discuss liquid or soluble options for routine medication with your GP or pharmacist.
• If you use hospital transport, let the transport service know you'll be at the hospital for longer on clinic days, or if you need to collect a prescription. More information is available from your transport service.
• If you're having chemotherapy, you'll need to allow more time on chemotherapy days, see the chemotherapy section for details.

Radiotherapy planning

You will have a CT scan to enable the team to design your radiotherapy. As part of this appointment we will make a radiotherapy mask.

What is a mask?

A mask is individually made for each patient having head and neck radiotherapy. It is made from a thermoplastic material which is moulded to your shape. The mask will cover your head, face and shoulders. You can see and breathe through the mask.

The mask serves three purposes:

• it ensures that you are comfortably and securely in the same position every time you have radiotherapy treatment
• it helps you to keep still while the radiotherapy is being delivered
• any marks needed to position the treatment can be drawn on the mask and not on your skin

What can I do to prepare for the mask?

• Wear clothes that are easy to remove from your upper body. Thin strapped tops or underwear can be left in place if the straps can be off the shoulder. You will need to wear the same style top/ underwear for each treatment to reproduce the exact position you were in when the mask was made.
• The CT and treatment rooms can be cold. You are welcome to bring a small blanket/ cover for when you are lying down.
• Shave off beards or moustaches before you attend.
• Bring something to tie up any long hair.
• Please do not use hairspray the day your mask is made.
• Remove false eye lashes, eyebrows and hair pieces.
• Do not wear earrings or necklaces, remove nose or tongue piercings.
• Prosthetics and dentures may need to be removed for the procedure. Please wear these as normal to the appointment and discuss this with the scanning team.
• Please let the scan team know of any difficulty you may have lying flat on a CT couch.

You will be asked to lie flat on the radiotherapy CT scanner couch with your head, neck and body as straight as possible. You will need to have your shoulders in a relaxed neutral position, this can be hard when you are nervous, but the staff will reassure and advise you.

The position you are in when the mask is made is the position you will be in for radiotherapy treatment. It is important that you can maintain the position for 20 to 40 minutes. The radiographers will do all they can to achieve a comfortable position for you. The mask needs to fit securely in order to keep you still enough for accurate treatment. If the mask is uncomfortable, please let the radiographers know when they are making it. Sound can be exaggerated in the mask and normal noises can sound distorted, particularly while the radiographers are putting marks on the mask and positioning you for treatment.

How is the mask made?

You'll lie flat on the CT couch with your head, neck and body kept as straight as possible, and your shoulders relaxed. This can feel tricky if you're nervous, but staff will help you find a comfortable position.

The position you're in when the mask is made is the same position you'll be in for every treatment, so you'll need to hold it for 20 to 30 minutes. The radiographers will do all they can to make this comfortable. The mask needs to fit securely to keep you still. Let the team know if it feels uncomfortable while they're making the mask.

Your mask starts as a flat sheet of thermoplastic mounted on a shaped frame. Once you're lying on the CT couch, this sheet is warmed in a water bath for a few minutes until it becomes flexible. The warm, flexible thermoplastic is then lifted out of the water bath and stretched over your head and shoulders. The frame is clipped to the CT couch to stop the material shrinking and help you keep still. It'll feel warm and wet while the impression is taken, and you'll be able to breathe normally throughout. The material is then smoothed to the contours of your face and shoulders. The material cools and takes on your shape while the team do the radiotherapy planning CT scan. After the mask has set it is lifted off keeping your exact shape. It's refitted each time you come in for radiotherapy.

Sound can seem louder or distorted inside the mask, especially while the radiographers are marking it and positioning you. This is normal

What is a mouth bite?

Some patients need a mouth bite, made from dental putty moulded around your teeth. It keeps your tongue and lower jaw in the same position for every treatment. You'll breathe normally through your nose or mouth, and it doesn't hurt. If you wear full dentures, these are usually removed for the mouth bite, though your gums may struggle to hold it securely.

The mouth bite is made just before the mask, and the CT team will talk you through it.

What is the radiotherapy planning scan?

Once your mask (and mouth bite, if needed) is ready, you'll have a planning CT scan as part of the same appointment. This takes around 30 minutes, but please allow around 1h 30min in the department.

The radiotherapy doctors (clinical oncologists) use the planning scan to draw where the radiotherapy is to be given. They also draw around important structures to avoid with radiotherapy or measure radiotherapy dose to. It is often necessary to have contrast for this CT scan to help them see the structures they need to outline. Contrast is a dye that is injected into the vein during the CT scan. The head neck team will be able to advise you if this is required.

Pre-treatment telephone clinic appointment

Before treatment starts members of the head and neck team will call to answer your questions and explain how they'll support you:

Advanced practice head and neck radiographer:

• Answers questions about radiotherapy or chemotherapy
• Talks through the treatment process, appointment schedule and review clinics
• Explains skin and mouth care (see the guide in this leaflet)
• For chemotherapy patients, explains the schedule and any side effects

Specialist dietitian:

• Explains how they'll support you through treatment
• Gives dietary advice and records your weight

Specialist speech and language therapist:

• Explains how they'll support you through treatment
• Assesses and advises on swallowing, voice use, jaw exercises and, if relevant, stoma care

Logistics during radiotherapy treatment (please read before your pre-treatment call)

Treatment is given using a machine called a linear accelerator (LA). You'll see this referenced on your appointment list, for example LA3.

• Each session is the same and takes around 15 to 20 minutes in total
• Radiographers position you on the couch and fit your mask. Using lasers and the marks on the mask they will line you up accurately for treatment.
• The team then leave the room to deliver treatment from the treatment delivery area, watching you on CCTV and speaking to you via intercom throughout. Raise your arm at any point if you need attention during this time, and the treatment team will stop the machine and come back into the treatment room.
• A short daily scan checks your position before treatment starts. This is painless and doesn't need any contrast dye.
• There's a brief pause while the radiographers check the scan from the treatment delivery area.
• Once your position is confirmed, treatment is delivered. The machine doesn't touch you and there's no sensation from the beams. This part usually takes four to nine minutes, though it varies by treatment area.
• Once the treatment has finished, radiographers come back into the treatment room and remove your mask.

The department runs regular fire alarm tests. If the alarm sounds while you're in your mask, it's most likely a test, staff will only remove you from the room if a genuine evacuation is needed.

Weekly radiotherapy clinic review appointments

Each week during treatment, you'll have a telephone or face-to-face appointment in the on-treatment clinic, plus separate appointments with a speech and language therapist and dietitian. Clinical nurse specialist support is also available through these clinics.

• You'll see either a radiotherapy doctor or advanced practice radiographer.
• These appointments are your chance to discuss side effects, ask questions, and get any medication, mouthwashes or creams prescribed.
• Allow more time in the department if you're being seen face to face.
• Use prescribed medication regularly to get the most benefit.
• To avoid running out, bring a list of what you need to clinic, and try to request repeat prescriptions a day before you need to collect them. This helps avoid long waits at pharmacy.
• If you take routine medication for other conditions, this should continue to be supplied as normal, via your GP.

Driving to radiotherapy

Side effects, especially tiredness, tend to build up as treatment goes on. You may be fine to drive yourself in the early weeks, but it's worth planning for lifts as treatment progresses. Some medications used during treatment can make you drowsy, so don't drive or operate machinery while taking these. If you need hospital transport, ask radiotherapy reception for your area's contact number.

After Treatment completion

• Two weeks after finishing radiotherapy, you'll have a review appointment (in person or by phone) with the advanced practice radiographer, speech and language therapist and dietitian, to check your side effects are settling and record your weight, with blood tests if needed.
• Around 6 to 8-weeks after finishing treatment, you'll attend the joint head and neck clinic to see a specialty surgeon or oncology doctor for follow-up, with access to the clinical nurse specialist, speech and language therapist and dietitian at the same visit

Chemotherapy with radiotherapy

If chemotherapy is recommended alongside your radiotherapy, the oncology team will discuss this with you. It's given in the Oncology Day Unit, level 2 outpatients, next door to the Radiotherapy Department.

• Cisplatin is given weekly or every three weeks during radiotherapy; separate written information is provided, and further details are on the Macmillan website
• Chemotherapy days involve a day case admission of around 4 to 5 hours; your appointment time is often only confirmed at your pre-treatment appointment
• Radiotherapy is given on the same day, after chemotherapy finishes, book in at radiotherapy reception once you're discharged from the day unit.
• Weekly blood tests are needed throughout and will be added to your treatment schedule.

Radiotherapy side effects (read this before pre-treatment appointment and keep referring to it during your radiotherapy treatment)

Side effects depend on the area being treated and vary from person to person, so not everything listed here will apply to you. Your team will go through what's relevant before treatment starts.

• Side effects tend to build slowly, usually becoming noticeable around week two.
• Side effect tend to reach their peak in the final couple of weeks of treatment and for two to three weeks afterwards.
• Side effects then start to settle. Healing takes time and can fluctuate. It can and take weeks to months for side effects to improve.

What can I do to help reduce my side effects?

• It is recommended to stop smoking as soon as possible, and before radiotherapy treatment starts. Continuing to smoke during radiotherapy means the treatment side effects tend to be worse, and treatment doesn't work as well.. Your GP or local stop smoking service can help with smoking cessation.
• Maintain nutrition and hydration. Seek advice from the dietitians if needed.
• Follow the skin and mouth care advice in this leaflet. The head and neck team will advise on managing side effects and prescribe any medication or mouthwashes needed.

Some patients find side effects hard to cope with despite their best efforts, occasionally a hospital admission is needed to help manage this. If your side effects aren't well managed and you need to be seen outside your scheduled clinic review, let the treatment radiographers know when you attend for your treatment appointment. If your appointment is in the morning, speak to the treatment team when you arrive. If treatment is in the afternoon, and you feel you need to have a same day review, please telephone radiotherapy reception (see contacts on the first page) to arrange coming in earlier. Please bear in mind the team may be in other clinics, so there could be a wait, or you may see the on-call oncology doctor instead.

Early (Acute) side effects

Early (Acute) side effects usually appear two to three weeks into treatment and settle in the weeks after finishing. Late effects are those appearing six months or more afterwards.

Hair loss

Hair loss can affect the treatment area (usually facial hair or the back of the neck; the scalp is rarely treated), starting around two to three weeks in. Regrowth can take a few months, though hair within the treatment area often doesn't grow back. If your scalp is affected, wash gently with a mild baby shampoo, towel dry, avoid heat on a hairdryer, and skip perming or colouring products while you're being treated.

Skin changes

From around week 2 onwards, skin in the treatment area will gradually redden, and may become dry, itchy or sore. Towards the end of treatment it can occasionally break down and become moist or ulcerated. Healing usually takes four to six weeks after finishing treatment, though some discolouration can linger for months.

Starting proactive skin care from day one helps reduce problems later, and should continue for several weeks after treatment until things settle. The following advice can help manage skin changes. In the treatment area:

• Wash daily with a mild soap or soap substitute, and pat dry rather than rubbing.
• Sparingly apply a fragrance-free moisturiser twice daily (more often if needed), allowing at least two hours before radiotherapy for it to absorb, and gently removing any excess before your session.
• Use an electric shaver rather than a wet razor, and a thin layer of petroleum free lip balm on the lips if needed (not before treatment).
• Avoid perfumed products, cosmetics, tight clothing, tapes or adhesives, and wax or hair removal products on the treated area.
• Avoid heat, sun lamps or cold packs on the skin, and protect it from sun and wind.
• Avoid heavily chlorinated pools, hydrotherapy, saunas and steam rooms, and don’t use sun beds.

Levels of skin reaction

• Erythema – reddening/darker areas of skin, sometimes with hair loss nearby. Follow the general skin care advice above.
• Dry desquamation – reddening with dry, flaky, peeling skin. Moisturise more often (keeping it in the fridge can help soothe), minimise friction, and protect from sun and wind. Ask the team to assess your skin if it becomes itchy or sore.
• Moist desquamation – skin breakdown with clear or yellow oozing. This is a normal reaction that should heal two to three weeks after treatment. It is often worst in the week just after finishing. Don't apply cream to broken areas unless prescribed, but continue moisturising unaffected skin. Ask the treatment team to assess it, or contact the head and neck team for advice.

If your skin hasn't healed after treatment, contact the head and neck team.

After treatment (skin)

Continue this skin care routine for three to four weeks after treatment finishes, or until reactions settle, extending for another one to two weeks if soreness lingers. Then return to your normal routine.

For the first year afterwards, protect the treated skin from the sun with a high-factor sun cream (worth continuing lifelong, as the skin stays sun-sensitive) and a brimmed hat.

You can return to swimming once your skin has healed, stopping and waiting a couple of weeks if the water irritates it.

The treated area may feel more fragile and look darker for several months, sometimes up to a year, and occasionally this doesn't fully resolve.

Let the team know if you notice: excessive, discoloured or foul-smelling discharge, or sloughing/excessive peeling in the treated area.

Sore mouth (oral mucositis causing pain, ulcers and bleeding)

Good mouth care keeps your mouth clean, moist and comfortable, and helps protect your teeth, this matters both during treatment and afterwards.

Radiotherapy to the head and neck causes inflammation and ulceration of the mouth and throat lining, leading to pain, soreness, dryness and discomfort. This is expected, usually starting seven to 14 days into treatment.

Preventative advice:

• Use high-fluoride (5000ppm) toothpaste and an alcohol-free fluoride mouthwash, lifelong (ask if you haven't been prescribed these).
• Brush twice daily with a soft, medium-head toothbrush, avoiding rinsing for 30 minutes afterwards; gently brush your tongue if it's not too sore.
• Store your toothbrush head-up to air dry, and change it regularly.
• If you wear dentures, remove them at least twice daily or after meals, clean with a toothbrush and tap water, then soak and air dry before storing in water overnight. Leave them out as much as possible, you may find them harder to tolerate towards the end of treatment.
• Avoid commercial mouthwashes, dental floss if you're prone to bleeding or infection, and hot or spicy food and drink; stick to softer foods that are easy to chew and swallow.
• Avoid dental treatment during radiotherapy except in an emergency, ask your team for advice.

Useful advice:

• Rinse with warm water or a saltwater mouthwash (half a teaspoon of salt to 500ml water) at least four to six times daily.
• For dry, cracked or sore lips, use yellow soft paraffin or a water-soluble lubricant sparingly (not before treatment), such a Oralieve Nourishing Lip Care.
• Watch for white or creamy patches, a sign of thrush, which is common and easily treated
• Brush your tongue gently, back to front, up to four times daily if not too sore
• Stay well hydrated, particularly with water, and cut back on caffeine; sipping water, adding sauces and gravies to food, and using artificial saliva or sugar-free gum can help with dryness (if you have your own teeth, avoid Glandosane spray)
• Ask your dentist to check any loose teeth, ill-fitting dentures or decay

Your mouth will be assessed weekly at your on-treatment review clinic.

After treatment (mouth)

Radiotherapy leaves the jawbone and blood supply in the treated area weakened, and saliva production often reduced, both increase the risk of infection and decay, and rarely this can lead to osteonecrosis (permanent bone damage). Keep up four to six-monthly dentist and hygienist checks, and have dentures checked regularly for fit. Your own dentist can carry out routine work, but if a tooth needs removing this must be discussed with, or done by, the hospital's restorative dentistry or maxillofacial team.

Taste changes / loss

Both your sense of smell and the taste buds in your mouth affect your ability to taste. Your taste buds also depend on a good amount of saliva to help you taste well. Treatment that involves your nose, taste buds and/or saliva glands can affect your sense of taste.

This can mean that certain foods will change in taste, sometimes lose their taste completely or taste unpleasant. This often improves over time (months) but can be a longer-term problem depending on both the treatment volume and the area treated. This can impact on appetite and enjoyment of oral intake. The dietetic team will advise you on how to try to manage this.

Salivary and dry mouth changes

Radiotherapy affects the salivary glands, which can cause two different (sometimes overlapping) problems: thick, sticky secretions, or a persistently dry mouth.

Secretions can become thick, ropey and hard to clear from the mouth and throat, often discoloured (yellow or white) and worse first thing in the morning. They build up quickly again after clearing, and how much this affects you varies from person to person. This tends to be worst in the last week of treatment and for two weeks afterwards, before settling. It's a normal, if unpleasant, side effect.

A dry mouth happens because radiotherapy can reduce and alter saliva production. This can affect you during treatment and in the longer term, dose to the salivary glands is kept as low as possible to help protect this, and some recovery is possible afterwards, though this depends on how much the glands were exposed to.

For either problem:

• Stay well hydrated, secretions are less sticky and dryness more manageable if you're drinking enough.
• Saline or salt-water rinses (as above) or difflam mouthwash can help clear secretions.
• Keeping the air humid, or using gentle steam, can loosen thick secretions and make them easier to cough up
• Carrying a bottle of water to sip, moistening food, and trying salivary replacement products can help with dryness, this can be discussed in clinic.

Contact the head and neck team if secretions become difficult to manage, or if you're coughing them up from your chest rather than your throat. In the evening or at weekends, call the Acute Oncology Service (see contacts on the first page).

Difficulty swallowing (dysphagia)

Soreness in the mouth and throat can make eating and swallowing difficult. Maintaining good nutrition and avoiding weight loss is essential during treatment, your dietitian and speech and language therapist will support you with this at your weekly appointments. See the mouth care advice above for tips on managing food and drink.

Mouthwashes or medication can be prescribed to ease soreness and pain, this can be discussed at your weekly review, or sooner if needed, let the treatment team know if swallowing becomes difficult before then.

Voice changes

If your larynx (voice box) is in the treatment area, your voice may become hoarse. You should limit trying to speak and use alternative methods of communication, such as writing. The speech and language therapy team will review and advise you. This side effect is temporary and should return to normal in the weeks following the end of your treatment. Occasionally, patients are left with a slight alteration to their voice tone or pitch.

Reduced hearing / discomfort in the ear

Radiotherapy treatment can cause the wax in the ear to become stickier. This can block the ear and reduce hearing or cause discomfort. This can be treated and is usually temporary. Please let a member of staff know if you think this is happening.

Tiredness / fatigue

This side effect can vary greatly from person to person. Tiredness generally increases throughout radiotherapy and may last for several months after treatment has finished. It is important to listen to your body and pace yourself accordingly. You may find that you need to rest during the day. Fatigue can fluctuate and tends to be its worst in the two weeks following treatment. You can obtain further written information about coping with lethargy/ tiredness by contacting Macmillan Cancer Support (opens in a new tab).

Late side effects

Late effects are defined as those occurring six months or more following your treatment.

Dental decay (caries)

A drier mouth increases the risk of decay, since saliva normally helps clean the teeth as well as moisten food. See the mouth care after treatment advice above. Once your side effects have settled, continue brushing at least twice daily using Duraphat 5000 toothpaste and a fluoride mouthwash, lifelong.

Jaw muscle tightening (trismus)

The muscles around your jaw joints (in front of each ear) can stiffen if directly irradiated, making it harder to open your mouth comfortably. This tends to develop gradually over months. If it applies to you, the speech and language therapy team will assess you and recommend exercises, ideally started as soon as treatment begins and continued for some time afterwards.

Osteoradionecrosis

A reduced blood supply to the jawbone can occur if it's within the high-dose treatment area. This usually causes no symptoms unless infection develops, which can then damage the bone, this is known as osteoradionecrosis. The risk is higher if a tooth needs extraction after radiotherapy, particularly from the lower jaw. To reduce this risk a pre-treatment dental assessment is done to help identify and treat any vulnerable teeth before treatment starts.

Lymphoedema

The lymphatic system is a network of vessels and glands throughout your body that helps fight infection and drain fluid between your cells. Many of these glands, called lymph nodes, sit in your neck, and treating head and neck cancer often means these nodes need to receive radiotherapy too (sometimes they've already been removed surgically as part of your treatment).

Radiotherapy to this area can reduce how well the lymphatic system drains, leading to fluid build-up or swelling, often under the chin (known as dewlap oedema). This usually improves over the following months, though it may not resolve completely, particularly if you've also had surgery to remove nodes in the past. Depending on your area, referral to Lymphoedema service can be arranged if needed.

Pituitary function

For a few patients it will be necessary for the pituitary gland to receive a dose of radiotherapy. This may affect the gland and its hormone production. This usually occurs a year or more after radiotherapy and is easily managed.

Thyroid function

For some patients the thyroid gland may receive a dose of radiotherapy. The thyroid is sensitive to radiotherapy and it can affect thyroid hormone function. This usually happens in the months following radiotherapy. An underactive thyroid can be diagnosed using a blood test and can be easily managed by your GP.

Sight changes

Changes in vision are only a side effect if the area being treated is directly near the eye. This would be discussed with you fully before your treatment starts.

Lhermitte’s syndrome

It is sometimes necessary for the spinal cord to receive a dose of radiotherapy if it is close to the area of cancer that is being treated. This can have a temporary effect on the cord. Lhermitte’s syndrome is caused by a temporary inflammation to the membrane that covers the cord. This inflammation can take four to six months to settle following treatment. Over this time you can experience some tingling or ‘pins and needles’ in your hands and feet. Very occasionally it can cause intermittent jerking of your limbs. Please contact the head and neck radiotherapy team if you have any questions regarding this.

Damage to spinal cord (myelitis)

In rare cases radiotherapy can cause permanent damage to the spinal cord. Any potential radiotherapy dose to the spinal cord is minimised, carefully measured and recorded. Please contact the head and neck radiotherapy team if you have any questions regarding this.

Risk of causing a stroke

Radiotherapy to the neck can increase the risk of having a stroke in later life. This happens because radiotherapy can damage the lining of the blood vessels in the neck over time, causing them to narrow or harden faster than normal (a process called accelerated atherosclerosis). Please contact the head and neck radiotherapy team if you have any questions regarding this.

Radiation risk

Receiving radiation may cause a new cancer to grow in the same area in the future. This is one of the rarest side effects of treatment. Please contact the head and neck radiotherapy team if you have any questions regarding this.

Free prescriptions

All cancer patients are entitled to free prescriptions. Application forms (FP92A) can be collected from pharmacies, doctor's surgeries and in the oncology centre.

Stop smoking advice

We advise all patients to stop smoking. For information and support on smoking cessation contact your GP or local stop smoking service.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and / or specialist one-to-one care is required.