At Mater Private's Radiotherapy Centre in Limerick, all common cancer sites are treated, including radical treatment for prostate, breast, lung, head and neck, colorectal and gynaecological cancers. Palliative treatment is also available with priority access given as necessary.
When to Refer - RED FLAG SIGNS
There are a diverse range of symptoms and signs which can raise suspicion of an underlying malignancy.
A clinical assessment should include a thorough history and examination of the patient, focusing on duration of symptoms, the presence of past history of malignancy, gynaecological history, smoking history, alcohol consumption and family history.
Warning indicators prompting further investigation include, but not limited to:
- Persistent unexplained weight loss, energy loss
- New-onset headaches and/or new, sudden neurological complaints
- Non-resolving neck lump, oral cavity lesion
- Dysphagia, altered bowel habit, rectal bleeding, persistent nausea and vomiting, jaundice
- Breast lump, axillary lump
- Recurrent lower respiratory tract infections
- Persistent abdominal pain, abdominal mass
- Abnormal vaginal bleeding, persistent pelvic pain
- Prostatic symptoms, malignant-feeling prostate gland
- Testicular swelling
- Palpable lymphadenopathy
- Limb mass, swelling
- Abnormal blood tests
- Brain, including pituitary
- Head and Neck
- Gynaecological – cervix, endometrium, vagina, vulva
- Upper GI – oesophagus, gastric
- Lymphoma & myeloma
- Soft tissue sarcoma
- Skin, including melanoma
Palliative radiotherapy is delivered in order to improve patient quality of life, reduce troublesome cancer-related symptoms and prevent or delay tumour related complications.
The palliation of cancer-related symptoms accounts for a large proportion of the patients treated at our centre. Some examples of indications for palliative radiotherapy include:
- Malignant spinal cord compression (emergency indication)
- Superior vena cava obstruction
- Brain metastases
- Painful bone metastases
- Haemoptysis, haematemesis, PV bleeding
- Local malignant obstructive symptoms – including recurrent obstructive pneumonia, bladder outflow obstruction
- Ulcerating malignant skin lesions
In general patients are managed here in the centre and will contact us to discuss side-effects but from time-to-time they may present to their GP with problems.
Time is taken before treatment commences to discuss with the patient any possible side-effects and strategies are put in place to help manage their impact on quality of life. As part of their care plan, patients are reviewed at least once weekly whilst receiving radiotherapy and again 6 weeks after completing treatment in our review clinic.
The severity and extent of side effects is determined to some extent by a number of factors:
- the total dose of radiotherapy delivered to the site
- the daily dose of radiotherapy delivered
- the duration of the treatment course
- the anatomical site being irradiated especially if the same site is being re-irradiated
- the delivery of concurrent chemotherapy
- active smoking
- underlying medical comorbidities.
Types of side-effects
Acute radiotherapy side effects are defined as those happening between the time interval from day 1 of commencing radiotherapy to day 180 (6 months). Long-term side effects are any side effects taking place after this time. Acute side effects are predictable and usually temporary. Long-term side effects tend to be permanent. Acute side-effects are managed during and immediately after completion of the treatment course. The presence of long-term side-effects is established in follow-up clinics.
Common acute side-effects
- Radiotherapy induced fatigue
- Alopecia if the brain/skull is irradiated
- Radiation dermatitis
- Mucositis eg mouth ulcers, oral cavity and throat discomfort
- Nausea, altered bowel habit, cramps
- Urinary frequency
- Long-term Side-effects
- Skin fibrosis, skin dryness
- Cardiac damage
- Radiation pneumonitis
- Radiation-induced malignancy (1/200 chance at 10-15 years)
- Cognitive decline
ABOUT TREATMENT DELIVERY
If you would like more information regarding treatment delivery options in the management of patients, including External Beam, Brachytherapy, Radioactive Seed Implantation (RASI) please visit the Radiotherapy section. We work closely with the Cancer Centre and the Oncology Department here in Limerick University Hospital.
For certain forms of cancer, chemotherapy is also given before, during or after a course of radiotherapy.
- Neo-adjuvant chemotherapy is given before definitive surgery in some breast cancer patients, particularly locally advanced tumours at high risk of harbouring micrometastatic disease. In borderline resectable tumours the rationale behind this sequencing of treatment is to shrink the primary tumour to increase the potential of performing breast conservation surgery. Neo-adjuvant chemotherapy (followed by surgery and/or radiotherapy) is also sometimes used in the treatment protocols for oesophagus, gastric, lung and head and neck tumours.
- Concurrent chemotherapy is given during a course of radiotherapy. This is commonly practiced for head and neck, cervix, rectal and lung cancers. The rationale behind this sequencing of treatment is the radiosensitising ability of certain chemotherapeutic drugs. This enhances the radiotherapeutic effect and can sometimes enable a lower overall total radiotherapy dose, thus sparing potential long-term radiotherapy side effects.
- Adjuvant chemotherapy is given after definitive surgery for some cancers if there is concern about adverse risk features after pathological analysis eg. breast, lung, colorectal, gynaecological, head and neck cancers.
- Sequential chemoradiotherapy is chemotherapy and radiotherapy given in sequence rather than at the same time. This is commonly used in the management of inoperable lung cancer (although a concurrent approach in associated with superior outcomes but is more toxic), and in the adjuvant treatment of certain endometrial cancers.
The Mid-Western Cancer Centre is enrolled in a large number of clinical trials.
Clinical trials are an integral component of the development, individualisation and enhancement of cancer treatments. Patients may be offered to participate in clinical trials but are under no obligation to agree to participate. Please do not hesitate to ask us if you would like to find out more about clinical trials.
For a full list of trials please visit the Cancer Trials Ireland.