Head and neck cancer

Welcome to Cancer Care Services at the Royal Brisbane and Women’s Hospital.

You are here today to begin your journey through radiation therapy to the head and neck region.

A radiation therapist will come greet you in the waiting area and bring you through to one of
our radiation planning rooms.

Your radiation planning session is a critical component of your radiation treatment.

You will be required to remove the following before your CT scan – any jewelry from your head
and neck, dentures or plates, clothing from your upper body. And if you have a beard, we do require you have it trimmed right back.

The staff will start with you in a sitting position on the CT bed. We use a laser system to ensure you are straight and level when lying down.

Do your best to remain as relaxed as possible during the simulation process. When you are tense and stressed, you will hold your body in a much different position to when you are relaxed.

It is important to make sure we can position you exactly the same each day for treatment as you were in your planning session. We move you around until we get the ideal treatment position. Do your best to allow us to do these movements for you.

In most circumstances, we will create a personalized mold for you called a Vac bag. It is a beanbag that we mold to cast a defined impression of your head, neck, and shoulders. We mold the bag around you, then remove all the air, which will lock your shape into the bag.

This is not required for all head and neck treatments.

Your radiation oncologist may be required to come in and mark on your important areas of interest for your treatment using non-permanent pen. This may include marking a scar creating a wax structure or mouthpiece to open your mouth.

We may also need to tape wire onto your skin’s surface so that we can see the oncologist markings on your CT scan.

In the next step, we make a mask.

It starts out as a flat piece of plastic material. We heat it in hot water so that it can be molded. It has a hole for your nose and perforations throughout so you can breathe easily.

When the mask touches your skin, it will be soft, warm, and slightly wet. It will form a perfect cast of your head, neck, and shoulders. Its purpose is to support you and keep you in the exact same position for treatment.

We will cool the mask using ice packs, then place marks onto the mask so that we can set you up in the same position for treatment.

We will then move you into the CT scanner.

It is important to stay as relaxed and still as possible, and, of course, breathe normally throughout the scan. It only takes a few minutes.

Once the scan is finished, we will return to the room, remove you from the CT scanner, and record on paper and with photos all the aspects of your planning session.

At the end of your planning session, a radiation therapist will walk you back to the waiting area to book in your first treatment appointment.

You will leave today with your first appointment date and time on your appointment card, which you need to bring with you each day.

For further information regarding your treatment, please refer to other videos in this education series. Or feel free to speak with any
member of cancer care team.

Welcome to Cancer Care Services at the Royal Brisbane and Women’s Hospital.

You are here today to begin your course of radiation therapy to the head and neck region.

You will be treated on one our five treatment units. This is predetermined by your radiation oncologist depending on your individual clinical circumstances.

You will likely be treated in the same room each day while on treatment. However, you may be treated in the other identical treatment rooms from time to time.

Once our treatment room is ready, we will guide you into the room.

Each day we are required to ask you your full name, date of birth, and the area of your body you are having treated.

We have music playing in the room. But if you prefer no music or your own music played, please let us know.

We start by sitting you on the treatment couch and then carefully lay you down.

The radiation therapists will now reproduce your position from your simulation session. Do your best to remain as relaxed as possible during the treatment process. When you are tense and stressed, you may hold your body in a different position to when you are relaxed.

We will then secure your mask in place.

As we raise the treatment couch, we dim our lights and use lasers to reproduce your position.

Our adjustments to your position are very small. Do your best not to help and allow us to perform movements for you unless asked.

If it feels too tight or uncomfortable in any areas, let the team know.

Once happy with your position, we will advise you that we will exit the room. This will also be signified by an audible indicator.

[AUDIBLE INDICATOR SOUND]

It is your job to remain as relaxed and still as possible, as any movements you make will require us to restart your setup.

You may be in the room by yourself for up to 15 minutes daily, but this will vary from day-to-day depending on many factors.

From outside the room, we take a series of images that we use to accurately target your treatment site. We may re-enter the room to adjust your position physically or by moving the bed from outside.

We are now ready to commence your radiation treatment.

Whether you were treated on a linear accelerator or TomoTherapy therapy, radiation is delivered with the same intent, just with a different approach. Both machines will make different noises during the delivery of the radiation, and as the machine rotates around you.

You will receive the same amount of radiation daily as prescribed by your own oncologist.

You will not feel anything during the treatment.

Be sure to breathe normally at all times. We are watching you on closed-circuit cameras from outside the room while delivering your treatment.

If you need us for any reason, carefully wave your hand and we will come in to help you out.

Once completed, we immediately return to the treatment room, remove your mask and bring the bed down.

Please stay still until you are told it is safe.

Your treatment is now complete. You can dress yourself and head home.

You should not have experienced any pain or sensation from the radiation delivery, and it is safe to be out in public as you are not radioactive.

It is important to discuss with the treatment team any concerns or issues you may have during the course of your treatment.

You will have been given your next day’s appointment time and your estimated finish date for treatment.

For further information regarding your treatment, nursing care, or support services, please refer to other videos in this education series, or feel free to speak with any member of our cancer care team.

Radiotherapy or radiation therapy kills cancer cells using high energy X-rays that are generated electrically.

The radiation is directed to the specific area of your body that requires treatment.

Radiation therapy is normally given daily, but can be delivered as a single treatment or over a period of up to six weeks

Treatment each day can take from ten minutes to up to an hour, depending on what area of your body is receiving the treatment.

There are two different ways that radiation therapy can be given, externally and internally.

The most common method is delivered externally using machines called linear accelerators. These machines are like X-ray machines on steroids.

In our department, we also have TomoTherapy machines, and we have a specialised technique called total body irradiation for bone marrow transplant patients.

All radiation therapy machines target the radiation into the specific area being treated in your body.

With external radiation therapy as soon as the machines are turned off the radiation is no longer being produced.

You are not radioactive, so it’s safe to shower, use shared bathrooms, kiss, hug, have protected sex.

It didn’t really feel like anything. It was kind of like an MRI, if you have one of those before. I just laid there with my eyes closed, chilled out. It smelt kind of weird, and it’s hard to explain kind of like a metallic smell.

Radiation therapists are the people who in conjunction with the radiation oncologist, design and deliver your radiation therapy treatment.

Our department is located on level three of the Cancer Care Precinct within the Joyce Tweddell building of the RBWH.

The Sony You Can Centre, located on level six of our building, is a purpose built recreational space for AYA patients.

So if you feel like taking a break away from the waiting areas or wards, there is a space specifically designed for our young people.

Radiation therapy is designed personally for you.

A radiation oncologist worked with a team of specialists across the entire health service to provide you with recommendations regarding the best treatment for you.

As your radiation treatment is custom designed, you will be seen in the radiotherapy department a few weeks before your treatment starts.

At this appointment, a CT scan of the area of your body is a must, and sometimes personalised equipment is created for you to help you stay still and make your treatment precise.

It is very important for you to be as comfortable as possible, and therefore, if it isn’t, please let us know.

So I had full body irradiation. So I was put on a bed lying flat, and I had, they made a cast of my body and I was wrapped in that, and had a lot of sand bags put on top of me.

I don’t know the technical names because I do not care to know. First lot of treatment, a face cast was used with a vacbag behind me just to make sure that I’m held nice and secure in place. And for the second lot of treatment, none of that was used and the machine rather spun around me, which provided me with a little bit more ease.

So the linear accelerator, which is the radiation machine and I had a mask made. So this one here, which is my little face and my favorite piece of equipment used was the speaker. So you can use that to like, play your own music. Which was really awesome.

Just like an x ray, you should not feel anything when you’re having your treatment.

The way radiation works, it also affects the cells around the area of the body being treated.

You may experience some side effects after your first week of treatment.

Your radiation oncologist will discuss your potential side effects before your treatment starts.

Side effects experienced are usually dependent on where you’re having treatment.

If you begin to experience any of them, make sure to tell the radiation oncologist, radiation therapists or the nursing team within your centre.

With the first intensive radiation therapy I experienced very intense side effects, muscle pain. It burnt the inside of my throat and I couldn’t swallow. But as I was getting ready for a transplant, that was all to be expected and kind of, you know, exacerbated by other chemotherapy treatments.

With the second lot of treatment that I had that was daily for a month, the side effects were a lot less, you know, that was just a bit of tiredness, fatigue and joint pain, but no severe burns or discomfort when swallowing was experienced.

Just the soreness of where the radiation was targeted towards me, which in my case was my chest, and that was really it. There’s no other side effects, which was great.

So my side effects were I was sick after every single treatment. And because I was getting it on my head as well, I lost my hair.

So going into it, I kind of just accepted the fact that my body may not react nicely to treatment, so I didn’t put any pressure on myself to uphold my lifestyle. And looking back like, I’m really glad I did that because I was really fatigued throughout the whole thing. I would say, if you’re getting it five days a week to maybe plan for weekends, maybe a Sunday, because I was still quite tired on a Saturday. And I think like really just like think about your body and if you wake up feeling ready for it and energised, then organise something then, but yeah, just listen to your body.

So during radiation, I made sure to go at my own pace. I made sure that any activities that were planned with me and my friends or family were less high energy and more socializing and just chilling.

I just kept it at one day at a time often to prepare yourself mentally and emotionally for the next session. I also tried to bribe myself with fun activities, lunches, coffees, anything that would work.

I kind of just had to power through it, realise that this is really going to help you in the future and that a small like couple of hours of uncomfortableness is going to result in you being able to hopefully be happy and healthy for a long time in the future.

I’d probably tell myself, you don’t need to be so strong, you know you can let yourself take it all in. Tt’s not a scary time, it’s something that you need to get better.

Just to look again, pay attention to your body, do whatever makes you happy, comfortable and gets you through it, whatever that is. I had Maccas after every single treatment, just do whatever works for you. Yeah, and this don’t put pressure on yourself. It’s a lot to go through. So mindfulness, self-care, eat whatever food you want, do whatever you can to get through.

I think for me, it, you know, I would tell myself that it’s so important to understand that it will pass. You know, the treatment cycle will finish, you know, your body will slowly recover. And even in the worst parts of it, you can get through by looking at the fact that you will be healthy and stronger again. And those feelings and smells and senses they will stop.

For more information about radiation therapy, please visit the Cancer Council website.

For more information about adolescent and young adult support services, please visit these websites.