Radiotherapy

If the sphincter muscles are affected or if the tumour covers the peritoneum (stage T3), if the tumour is already growing into neighbouring organs (stage T4) or if there is lymph node involvement (N+), radiotherapy prior to surgery can significantly improve the conditions of the operation.
A preoperative radiotherapy, if necessary in combination with chemotherapy, shrinks the tumour and can, for example, significantly increase the chances of a continence-preserving operation with preservation of the sphincter muscle.
In a few cases, radiotherapy in combination with chemotherapy is only performed after the operation. This may be the case, for example, if it only becomes apparent during the operation that difficult conditions exist and that the tumour stage is higher than previous examinations would suggest.

In the case of rectal carcinoma, the lymph drainage channels of the pelvis are also irradiated in addition to the actual tumour.

If it is likely that the sphincter muscle will be preserved after the preceding radiotherapy, a temporary artificial bowel outlet is nevertheless usually created during the tumour operation. The stool is then discharged to the outside via the artificial bowel outlet and does not come into contact with the surgical wound. This accelerates and improves the healing of the wound, and the artificial bowel outlet can later be removed again.

If preservation of the sphincter muscle is not possible despite prior radio-chemotherapy, a permanent artificial bowel outlet is created instead of the temporary artificial bowel outlet.

First of all, the course of the disease (anamnesis) and an examination take place in the radiotherapy outpatient clinic. Here all findings are again rated and the possibility of radiotherapy is checked. After the written consent of the patient, a tomography with a so-called planning CT is performed.

This CT is used by the radiotherapist to plan the radiation therapy and determine your target volume. Subsequently, specialized physicists, the medical physics experts, take over the calculation of your radiation plan. The calculation of the irradiation plan may well take several working days. The medical physics experts divide the total dose into many smaller individual doses for better tolerance. This is why a series of radiotherapy sessions takes quite a long time - most patients are treated 5 x/week on Mondays to Fridays over several weeks. On weekends the patients have "free" time.  A typical irradiation session lasts about 20 minutes, but the irradiation device (linear accelerator) is only switched on for a few minutes. As with an X-ray, you are alone in the irradiation room during the irradiation. However, you can contact us at any time using cameras and an intercom system.

Radiotherapy can be partly carried out on an outpatient basis. However, if radiotherapy is combined with chemotherapy, or if more severe side effects are to be expected, it may be necessary to carry out the therapy under inpatient conditions.

Skin

The skin in the irradiation field often becomes dry and reddened. When a rectal carcinoma is irradiated, the probability of skin irritation or even skin burning is very low. Unfortunately, there is no kind of "sun cream" to protect the skin from radiation damage. However, daily skin care with cream or lotio provides a certain amount of skin protection. Therefore we would like to ask you to care for the irradiated skin area several times a day with a moisturizing lotio or cream. As a rule, the costs for skin care are not covered by health insurance.

Bowel

Since we irradiate your intestine in the case of rectal cancer, there is always intestinal irritation and from about the second week of irradiation, the stool frequency increases significantly. Some patients also report flatulence and even diarrhoea. In a few cases, intestinal loops become sticky or ulcers develop. Even more rarely, the formation of duct systems, the so-called fistula formation, occurs. In the case of diarrhoea, you should take in sufficient fluids and trace minerals.

Bladder

Irradiation very often leads to bladder irritation. Temporary increased urination occurs. Especially urination at night can be extremely annoying. During a series of irradiation, urinary tract infections also occur more frequently. Most patients can reduce these side effects by having their bladder filled during radiation.

Vaginal adhesions

In women, the vagina can become adhered during pelvic irradiation. In these cases, sexual intercourse can be considerably more difficult or even impossible; in this case, the prophylactic use of a dilator can help to minimize this risk.

Ovaries/testicles

The function of the ovaries or testicles can be permanently impaired by radiation, so that hormone production and fertility are reduced and possibly even completely eliminated. It may therefore be advisable for men to freeze sperm in a sperm bank before starting radiation therapy. If women wish to have children, they should also freeze parts of the ovary in specialised organ banks (cryopreservation) before initiating radiotherapy. In some cases, surgical relocation of the ovaries outside the radiation volume may be useful.

If your irradiation is accompanied by chemotherapy, immunotherapy or other systemic therapy, the effect on your tumour will be regularly increased. Normally, however, an increased rate of side effects can be expected.

Do not smoke!

The effectiveness of radiation and chemotherapy is significantly increased and the rate of side effects reduced when smokers quit smoking.

Skin care

Treat the irradiated skin area several times a day with moisturizing creams or lotions. Avoid strong sunlight and heat effects such as sauna, solarium, thermal baths or hot sitting baths. Showering with lukewarm water and mild soap is possible and allowed as long as your skin is intact.

Nutrition

Avoid flatulent and difficult indigestive foods such as raw fruit or vegetables and salads during the radiation weeks; as well as fatty, sharp-roasted or spicy dishes. Cooked vegetables, on the other hand, are better tolerated and allowed.