Overview

Radiotherapy uses radiation to treat cancer. High energy X-rays or similar rays damage your body’s cells within the treatment area. They kill the cancer cells but allow your normal cells to recover. The side effects of radiotherapy generally only affect the area you are having treated.

This information is about radiotherapy for skin (cutaneous) lymphomas, including cutaneous T-cell lymphoma (which includes Sézary syndrome and mycosis fungoides).

Cancer Research UK has more information about skin lymphomas.

Before having radiotherapy

You will have an appointment with a specialist cancer doctor (an oncologist). This appointment will be at the Cancer Centre at Guy’s.

Your doctor will discuss with you a course of radiotherapy, and any possible side effects. You will be asked to sign a consent form.

If you have any further questions please ask the radiographers when they ask you to verbally confirm that you wish to have radiotherapy.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you understand what it involves and agree to have the treatment.

You can read more about our consent process.

Planning radiotherapy treatment

Planning for your treatment usually takes place in the Radiotherapy Village (level R2), in the Cancer Centre at Guy’s.

Some of the treatment can be planned in the skin lymphoma clinic, if the skin advanced practitioner radiographer is in the clinic.

You will need to lie on the treatment couch.

Your doctor will use a marker pen to draw marks on your skin to identify the area to be treated.

The radiographer will record the treatment area by taking measurements and, with your consent, a photograph of the area.

Depending on the type of radiotherapy needed, and the area being treated, the team may need to make a mould of your features. We may need to make a lead shield to protect your skin around the area being treated. Or, we may need make a mould to keep you still during your treatment session.

These are made in the mould room, and the team will explain what the moulds are for and how they are made. Making the mould is painless but may involve the use of plaster of Paris (a powder which hardens when mixed with water).

A radiotherapy CT scan

You may need a CT scan to help the doctor to prepare your personal treatment plan.

• You may need to remove some clothing. You will be given a gown to keep you covered as much as possible.
• The radiographers will help you to get in position on the CT couch and your position will depend on the treatment area. They will make you as comfortable as possible. Please let them know if you are uncomfortable, as you will need to lie in the same position each day you come for radiotherapy.
• At the CT scan we may need to make some more marks which are permanent. These are small tattoos which look like tiny dots or freckles on your skin. These tattoos will be used every day to make sure you are in the correct position for the radiotherapy.

Having radiotherapy treatment

During treatment it is important that you stay still. The radiotherapy is painless.

Treatment depends on the type of radiotherapy you are having. Your doctor will let you know which you are having.

For treatment on the orthovoltage unit (ortho)

• You will be taken into the treatment room, and asked to lie in the same position you were lying in during the planning.
• We may need to protect your skin around the treatment area with a thin lead shield. This will be placed on your skin.
• Part of the radiotherapy machine will rest on your skin during treatment. You may feel a small amount of pressure on your skin because of this. The treatment is painless and you will not feel anything when the machine is switched on.
• Treatment can last 2 to 8 minutes.
• The radiographer will leave the room during the treatment but will watch you on closed circuit television (CCTV). If you need help, wave your hand. The radiographer can stop the treatment and return to the room to assist you.
• When your treatment ends, the radiographer will remove the marks on your skin made with the marker pen.
• You will be given details of further appointments if required and advice on how to look after your skin.

For treatment on the linear accelerator unit (linac)

• You will be taken into the treatment room and ask to lie in the same position you were lying in during the planning.
• If you had a mould made, or if we used tattoo dots, we will use these to make sure you are in the correct position.
• The radiographers will check some measurements and move the linac unit to the correct position for your personal treatment plan. 
• The radiographers will then leave the room. They will watch you on closed circuit television (CCTV). Wave your hand if you need help.
• You may feel the treatment couch move while the radiographers are out of the room. This is the team making tiny adjustments to make sure you are in the correct position for treatment.
• Treatment can last for about 5 to 10 minutes.
• When your treatment ends, the radiographer will remove any moulds and let you know when to get off the treatment couch.
• You will be given details of further appointments if required and advice on how to look after your skin.

Side effects of having radiotherapy

Any side effects will mostly affect the skin around the area you have treated. These include:

• If the scar is in an area where there is hair growing, there may be some hair loss. It may start to grow back a few months after treatment.
• The skin in the treatment area may change in colour, becoming more pink or red, and darker. Changes in skin colour may be more difficult to notice on darker skin. The skin may also be dry, flaky, sore, itchy and sometimes painful to touch. This slowly gets better about 7 to 10 days after treatment has finished.

Looking after your skin

It is important you look after your skin during treatment, and until any skin reaction has settled. Ask the radiographer if you need any further advice.

If your skin is unbroken:

• Skin around the treated area can be washed daily using plain lukewarm or tepid water. Avoid scrubbing, rubbing and exfoliating around the area.
• Pat your skin dry with a soft towel. Do not rub.
• Use a gentle moisturiser on the treated area.
• Do not use make-up or any other products on the treated area.
• Do not wet shave, or use hair removal creams, or wax around the treated area. You can use sterile scissors to keep hairs around the treated area low while the wound is healing.
• You can swim if your skin is not broken. Make sure you rinse off in the shower after swimming. Do not swim if your skin is broken.

Follow-up appointment

You will have a follow-up appointment with the doctor who referred you for radiotherapy. If you do not know when this is, please ask the radiographer on your last day of treatment.

Coping with diagnosis

This can be a worrying time. Changes in your appearance may be distressing to you, and to those close to you. 

Talking about your concerns can help you to find ways of coping. Staff caring for you can help you to find answers to questions or worries that you might have. They can also help you find out about other sources of information and support.

Dimbleby Cancer Care is for patients and carers attending the Cancer Centre at Guy’s Hospital. It provides information, psychological support and complementary therapy for people affected by cancer.