Radiotherapy for testicular cancer

Radiotherapy treats cancer by using high-energy x-rays, which destroy the cancer cells, while doing as little harm as possible to the normal cells (see Macmillan Cancer Support for more information). It is sometimes used to treat men with a tumour called a seminoma as an alternative to chemotherapy, but is not usually to treat a teratoma with radiotherapy. Seminoma are particularly sensitive to radiotherapy but they also respond well to chemotherapy which often causes fewer side effects and so radiotherapy is now not often used.

Radiotherapy is given to men with seminoma (usually aimed at lymph nodes in the abdomen) either to prevent the cancer coming back after the testicle has been removed, or to treat the disease if it has spread to the glands at the back of the abdomen.

Radiotherapy has to be carefully planned. On the first visit the patient may be asked to have a CT scan or lie under a machine called a simulator, which takes X-rays of the area to be treated.

The radiographer, who gives you your treatment, will draw marks on your skin to help position you accurately and to show where the rays are to be directed. These marks must stay throughout your treatment, and permanent marks (like tiny tattoos) may be used. The marks are very small and will only be done with your permission.

This tattooing does not hurt, and the marks help the radiographer to position the patient accurately during the radiotherapy. Most of the healthy tissue is shielded from the radiation beam.

Describes the tattoos that were put on his body before the radiotherapy started.

Age at interview 48

Gender Male

Age at diagnosis 34

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Before you can have radiotherapy they have to clearly identify which parts of the body they’re going to zap, I use the word zap because I don’t know any other word to use. And in so doing they have to be so accurate because radio waves, for want of a better description, are so invasive and so harmful whilst still being able to treat things like tumours, they have to be jolly careful where else in the body they’re going to put them. So it was explained to me that I would be going to a room with a replica machine of this machine that they were going to use, and that they had to measure from what the consultant had said on the x-rays, that they had to mark on my body where they were going to do the radiotherapy. So this was all very technical and they took a lot of measurements and they were forever consulting their, the x-rays of me and saying “Oh yes it’s got to go here and there.” And what they actually do, and they did explain it beforehand because I had to have the lymph nodes on the same side as the testicle and no other side, it was just the one side and they explained that they had to do it from below, just below groin to shoulder. But in order to do this and to make sure that they got the machine lined up correctly they had to put little marks on my body. And they’re actually tattoos so I can actually say I’ve got like 8 tattoos and nobody would ever know it but they’re tiny weenie little blue pinpricks and they follow the line of the radiotherapy on both your front and your back and they’re there, to this day they will never go away. Kind of a souvenir I guess.

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Radiotherapy is usually given daily, Monday to Friday, as an outpatient. A course of treatment usually lasts between two and four weeks.

The treatment itself only takes a few minutes and is painless. However, two men we interviewed reported feeling a strange sensation during treatment. One man remembered the sirens that went off as the radiographers ‘scurried’ from the room. Some remembered the beeps and buzzing noises that occurred when X-rays were taken. Others remarked on the massive machines, and remembered feeling scared and intimidated. One man said he felt a bit frightened at first, but eventually got used to it. One man commented on the beams of light and ‘space-age’ machines, and found the whole experience quite exciting.

Recalls that the radiotherapy machines were big, noisy and very scary.

Age at interview 29

Gender Male

Age at diagnosis 28

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So I had to lay very still for about ten minutes while they mapped my body and then they put five very small little tattoo dots on my chest, three down the centre, from the belly button up about four or five inches, then up four or five inches again and I think there was one either side. And the reason they did this as I said so when they go down to the proper machine they know exactly where to do it and also you get used to what the machine is like. So you know I had that then the next day I started my radiotherapy.

What is the machine like?

Big (laughs), big and noisy. It’s , you know I personally believe that these are the things that are the worst, the things that look the scariest are the things that do you the most good and are very over-awing you know very, very scary looking. So er the next day I went there and what was weird was, for me was I was expecting oh right you’d have to strip all your clothes off and no metal and all these things like this. And literally it’s very laid back and it’s a lot quicker than you think it is, you literally, with me I just went into a room, they asked me to take, not even take my shirt off fully into, undo my shirt, undo my trousers just pull them down slightly er and I had to lay very still. And then they marked some grids on your chest ad then they, they gave me like a, it’s about 25 second pulse. First of all what they do is they take an x-ray first of all to see if you’re lined up properly. Basically what they do is you lay very still and then they say “Look were going out the room for a second.” You hear a buzz noise and then you hear a weird hum for about five seconds, it stops and they come back in. And this is to make sure you’re in the right place. Then they say “Right okay were going to give you the treatment.

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Recalls that although radiotherapy is painless, he felt a vibration in his body.

Age at interview 26

Gender Male

Age at diagnosis 24

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It took about 15 minutes to wait for your turn and then it literally, I think it must’ve taken about one minute, from getting into the room and leaving. I’d lie down on a bed, they align the machine above you, take one, give you one blast above, above you, and one blast under you and the whole thing must’ve taken, may be a minute is an exaggeration, may be two minutes, a minute either side, and then that was it and you didn’t feel it. Oh one time I was sure, I asked the guy, I said I thought I felt a vibration in my body and he said some people do, you really can’t, but some people do. Whether it’s your mind, I was sure I felt something sort of flutter you know like I could feel it almost like, yeah but and then I made this comment to the guy and he said that some people do say that. But as far as you know you really shouldn’t be able to feel anything, he said theres nothing there to feel, so that was strange.

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Describes what it is like to have radiotherapy.

Age at interview 33

Gender Male

Age at diagnosis 32

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Yes, its January 2002, so its, let me think nearly four months or more, just over four months since I discovered the lump or what turned out to be the tumour and what’s it, three, three months after surgery I’m back to my full fitness and full mobility. And I’m started the course of radiotherapy as I said, and I’ve had four sessions this weeks, its gonna take ten sessions, every day for two weeks with the weekends off. The radiotherapy is actually fairly straightforward you know, I go in just after nine in the morning, I’ve been seen fairly promptly so far. Go in, bare my sort of lower abdomen so that they can see the targets that, where, I had applied at the planning session. And then it’s a matter of lying on the bench as they line up the targets, then all the radiologists, sorry radiographers scurry away, sirens go off, they obviously hid in some bunker as, as the machine cranks up and theres a sort of buzzing noise for about ninety seconds and then they turn the machine round and they do you both sides, and that takes about twenty minutes, sort of in and out, so, so far so good.

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Recalls that he did feel an unusual sensation during radiotherapy.

Age at interview 36

Gender Male

Age at diagnosis 29

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And when they started the machine I did actually feel, it felt as if I was in a static field, which was a bit of a shock because you know if they say “You don’t feel it,” and then you do feel something it’s (laughs), you know God is it working right or something you know (laughs). But er and that was it. The treatment probably lasted about 30 seconds, it seemed like a long time but it’s not, it’s actually only a few seconds. They, come from above you to start with and then the machine rotates underneath the table and they come from underneath, so they seem to do both sides of the torso. And I felt a little strange afterwards, couldn’t really describe how it was, I just felt different to how I did before the treatment.

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Says that when he started radiotherapy he felt a bit frightened.

Age at interview 53

Gender Male

Age at diagnosis 43

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You sort of are put in a room with a big machine around you with a whole load of lead weights on a sort of shelf above your chest and then all these people scuttle out, away from wherever this thing is and theres this sort of buzzing type noise. It doesn’t hurt or anything but it does feel a bit strange to be stuck there alone in this room, it’s a bit frightening. But I suppose after a month you get used to it, you can used to anything if you do it that many times. And when you look at the other people that were going for the same sort of treatment you think how lucky you are you know.

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The radiographers were often mentioned. One man said that they were friendly, explained everything, and gave him pills to prevent sickness (also see ‘Side effects of radiotherapy’). The radiographers also gave him instructions about skin care and washing.

Remembers the friendly radiographers, who explained everything and gave him pills to prevent…

Age at interview 39

Gender Male

Age at diagnosis 36

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But you know, I think where I went there was three different machines, three different radiotherapy machines so, but the nurses were great you know, I mean well they’re not called nurses, they’re radio, radiographers were, were great, they really were friendly, they sort of explained what they were doing. So that was good. But it’s just what you’re doing there. And it was seconds, the treatment was for seconds, you know I just went in there. You lay down there on the thing, they set the machine up and then you just get zapped for a few seconds I think, I can’t remember it was, yeah maybe ten seconds or something like that. And that’s it, then you get up and then you go. But the thing is what it does, because it was on the stomach particularly they said it does make you feel sick so they gave me some sickness tablets OK, to sort of stop the, the sickness.

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In very rare cases, radiotherapy is directed at the testicle itself. One man we spoke to, who had already lost one testicle, was given radiotherapy to try to kill the cancer cells in his other testicle, without destroying the healthy hormone producing cells.

Describes a rare situation, where radiotherapy was directed at his remaining testicle to try to…

Age at interview 39

Gender Male

Age at diagnosis 35

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So the next aspect of my treatment was I think in 98, October, November where I had radiotherapy. The idea was to be sure that there was no pre-cancerous cells left in there and the idea was to get the dose just right such that the hormone generation was maintained. And the can, pre-cancer cells were killed because if you’re gonna kill off your hormone generation there is no point in saving the organ. So I think it was ten consecutive week days where I had to go up and have a, a short bout of radiotherapy the, the queues and waiting I did it in the afternoons so I used to go into work in the morning and then go off for my radiotherapy in the afternoon. So sometimes I could actually wait about five minutes, sometimes best part of an hour so I did chance me arm and try and get in earlier occasionally. And you did all that for I don’t know probably about thirty seconds worth of treatment!

Just directed at the right testicle?

Yeah what they do, all they do is they go in there, again you undress, lay on the bench and then theres a small dose of radiotherapy to the right testicle which was just to, belt and braces, to make sure that there was nothing left.

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