Introduction
Chemotherapy is a type of treatment for cancer where medicine is used to kill cancer cells. It can be given either as a tablet, or as an injection or infusion directly into a vein.
Cancer
Cancer refers to a number of conditions where the body’s cells grow and reproduce uncontrollably. The rapid growth of cancerous cells is known as a malignant tumour. These cells can spread out of the tumour and into other parts of the body to form new tumours.
How chemotherapy is used
There are four main ways that chemotherapy can be used:
To try to cure cancer completely – this is known as curative chemotherapy
To help make other treatments more effective – for example, chemotherapy can be combined with radiotherapy (where radiation is used to kill cancerous cells), or it can be used before surgery
To relieve symptoms – a cure may not be possible for advanced cancer, but chemotherapy may be used to relieve the symptoms and slow the spread of the condition. This is known as palliative chemotherapy
To reduce the risk of the cancer returning after surgery or radiotherapy.
Side effects
Chemotherapy is a very effective cancer treatment and has helped save millions of lives. However, it does cause side effects.
The medications used in chemotherapy are not very good at telling the difference between fast-growing cancer cells and other types of fast-growing cells. These include blood cells, skin cells, the cells on the scalp and the cells inside the stomach.
This means that most chemotherapy medications have a poisonous effect on the body's cells. Common side effects include:
Feeling tired and weak all the time
Feeling sick
Being sick
Hair loss, although this can sometimes be prevented using a technique called a cold cap
Some people only have minimal side effects. However, for most people, a course of chemotherapy can be very unpleasant and upsetting.
In many cases, having chemotherapy will make you feel worse than the cancer you are being treated for.
Living with and adapting to the side effects of chemotherapy can be challenging. But it's important to realise that most, if not all, side effects will disappear once the treatment is complete.
Some people who are about to start chemotherapy are concerned that the harmful effects of chemotherapy can be passed to other people, particularly people who are vulnerable, such as children or pregnant women. However, there is no risk associated with coming into close contact with someone who is having chemotherapy.
How chemotherapy works
There are over 50 different types of chemotherapy medication which can be used to treat hundreds of different types of cancer.
However, they all work in one of the following two ways:
They stop cells from reproducing, which can be very useful in preventing the spread of cancer.
They essentially "trick" cells into self-destructing.
All human cells have a limited lifespan. They eventually die and are replaced by new cells. Chemotherapy medications make the cancer cells "think" that their lifespan has finished.
Depending on the type of cancer you have, you may be given:
Monotherapy – where only one chemotherapy medication is used
Combination therapy – where a combination of different medications is used
When is chemotherapy given?
Depending on the type and severity of your cancer, chemotherapy will be given at different stages of your treatment. You may receive chemotherapy:
Before having surgery to remove a tumour or radiotherapy to shrink it, so that other treatments can then begin (this is known as neo-adjuvant therapy)
In combination with radiotherapy, which is known as chemoradiation
After having surgery or radiotherapy, which is known as adjuvant therapy
Chemotherapy protocols
You will need to have regular chemotherapy over a set period of time for it to be effective.
Dr. B C Shah will draw up a treatment plan that gives details of how many sessions you will need, how long the course should last, and how much time should pass between each session. It is common for there to be a break after each session to allow your body to recover from the effects of the medication.
This treatment plan is known as a chemotherapy protocol. Chemotherapy protocols vary depending on the type of cancer you have and how advanced it is.
An example of a chemotherapy protocol is:
One day of treatment
Seven days of rest
One day of treatment
21 days of rest
This cycle will then be repeated six times over 18 weeks.
Who can use chemotherapy?
Delaying treatment or, in some cases, not having chemotherapy may be recommended if you:
Are in the first three months of pregnancy – using chemotherapy during this time has a very high risk of causing birth defects
Have low levels of blood cells – chemotherapy can lower your blood cell count more, so it could make you feel very ill and, in some cases, vulnerable to infection. Medication and sometimes a blood transfusion may be required to raise your blood cell count
Have severe kidney or liver disease – most chemotherapy medications are processed by your liver and kidneys, so this could have a very harmful effect if your liver and kidneys are already damaged
Have had recent surgery or a wound – chemotherapy can disrupt the body’s ability to heal wounds, so it's usually recommended that the wound heals before treatment begins
Have an ongoing infection – chemotherapy can make you more vulnerable to the effects of infection, increasing your risks of developing serious complications
As chemotherapy is a potentially life-saving treatment, it is usually recommended for most people with cancer, even if they are in poor health and the treatment is likely to make them feel worse.
How chemotherapy is performed
Dr. B C Shah
Many hospitals use multi-disciplinary teams (MDTs) to provide chemotherapy treatment.
MDTs are teams of specialists that work together. Members of your MDT may include a:
Medical oncologist – a specialist in the non-surgical treatment of cancer using techniques such as radiotherapy and chemotherapy
Pathologist – a specialist in diseased tissue
Haematologist – a blood specialist
Psychologist – who can provide support and advice about the psychological and emotional impact of chemotherapy
Clinical nurse specialist (CNS) – who will offer you support throughout your care, from diagnosis.
As well as having a specialist MDT, you may also be assigned a key worker (this is often the CNS). You will be given their details so that you can get in touch with your team at any point during your treatment. They will also be involved in coordinating your care.
Deciding what treatment is best for you can often be confusing. Dr. B C Shah will recommend what they think is the best treatment option, but the final decision will be yours.
Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask Dr. B C Shah.
For example, you may want to find out:
What the purpose of your chemotherapy is – for example, whether it's being used to cure your cancer, relieve your symptoms or make other treatments more effective
What side effects you're likely to experience and whether anything can be done to prevent or relieve them
How effective the chemotherapy is likely to be at curing your cancer or at least slowing it down
Whether any alternative treatments can be used instead of chemotherapy
Blood tests
Before chemotherapy begins, you will need to have a number of blood tests to assess your health and to make sure you can cope with any side effects.
Blood tests are useful for assessing the health of your liver and kidneys. This is important because chemotherapy medications will pass through your liver and kidneys, where they will be broken down. The medication can harm the liver. Therefore, if you have liver damage, it may not be suitable for you until your liver and kidneys have recovered.
Another important role of blood testing is to assess your blood count. This is a measurement of how many blood cells you have.
There are three types of blood cell:
Red blood cells – which carry oxygen around your body
White blood cells – which help fight infection
Platelets – which help the blood to clot (thicken)
Chemotherapy reduces the number of all three types of blood cells.
If you have a low blood count, treatment may be delayed until your blood count has returned to normal. Alternatively, medication can be used to raise your blood count. In some cases, a blood transfusion may be required.
You will have regular blood tests during your chemotherapy so that your liver, kidneys and blood count can be carefully monitored.
You may also need other tests to check how well the cancer is responding to treatment. The tests you require will depend on the type of cancer you have.
Types of chemotherapy
Chemotherapy is usually given in one of two ways:
as a tablet – which is known as oral chemotherapy
injected directly into a vein – which is known as intravenous chemotherapy
The type of chemotherapy you have will depend on the type of cancer and how advanced it is.
Oral chemotherapy
If you are in good health, you may be able to take your tablets at home. However, you will still need to go to hospital for regular check-ups.
It is very important that you only take your tablets on the days specified in your chemotherapy protocol. If you forget to take a tablet, contact Dr. B C Shah for advice. Also contact Dr. B C Shah if you are sick shortly after taking a tablet.
Intravenous chemotherapy
A number of different devices can be used to give chemotherapy medication into a vein.
The type of device used will often depend on the type of cancer you have and your general health. You may be able to choose which device you have, although this is not always possible.
Intravenous chemotherapy is not like having a vaccine, where you are given one quick injection. Instead, chemotherapy medications are slowly released into a vein over a period of time. The time it takes to give one dose can range from several hours to several days.
Occasionally, some people need a continuous low dose of chemotherapy medication over several weeks or months. If this is the case, you may be given a small portable pump that you can take home with you.
The devices used for intravenous chemotherapy are described below.
Cannula
A cannula is a small tube that is placed into a vein on the back of your hand or lower arm. Chemotherapy medication is slowly injected through the tube into your vein. Once the dose of medication has been delivered, the tube can be removed.
Skin-tunnelled catheter
A skin-tunnelled catheter is a fine tube that is inserted into your chest and connected to one of the veins near your heart. The catheter can be left in place for several weeks or months, so that you do not have to have repeated injections. The catheter can also be used to carry out blood tests.
Peripherally inserted central catheter
A peripherally inserted central catheter (PICC) is similar to a skin-tunnelled catheter except the tube is connected to your arm rather than your chest.
Implanted port
An implanted port is a chamber that can be inserted under your skin and connected to a nearby vein. A special needle is placed into the chamber and connected to a drip or used for blood tests.
Other medication
If you are having chemotherapy, check with Dr. B C Shah before you take any other medication, including over-the-counter (OTC) medicines and herbal remedies. Other medication could react unpredictably with your chemotherapy medication.
Pregnancy
You should avoid becoming pregnant while having chemotherapy. This is because many medications used in chemotherapy can cause birth defects.
You will need to use a barrier method of contraception, such as condoms, while having chemotherapy and for a year after your treatment has finished.
Contact Dr. B C Shah immediately if you think you may have become pregnant while having chemotherapy.
Side effects of chemotherapy
It is difficult to predict exactly what side effects you will experience while having chemotherapy. Different people react to treatment in different ways.
A small number of people have very few or even no side effects.
The common side effects of chemotherapy are listed below, although it is unlikely that you will experience them all.
Dr. B C Shah is there to help you cope with the physical and psychological side effects.
When to get urgent medical advice
While the side effects of chemotherapy can be distressing, most do not pose a serious threat to your health.
However, occasionally some side effects can be very serious. For example, if you have a rapid fall in white blood cells, you may be vulnerable to a serious infection.
People having chemotherapy for cancer that developed inside their blood cells or bone marrow are most at risk of serious infections. This is because this type of cancer will already have caused a reduction in white blood cell numbers.
Symptoms of serious infection include:
a high temperature of 38C (100.4F) or above
shivering
breathing difficulties
chest pain
flu-like symptoms, such as muscle aches and pain
bleeding gums or nose
bleeding from other parts of the body that does not stop after applying pressure for 10 minutes
mouth ulcers that stop you eating or drinking
vomiting that continues despite taking anti-sickness medication
four or more bowel movements a day, or diarrhoea
If you have any of these symptoms, contact Dr. B C Shah immediately.
Fatigue
Fatigue or tiredness is a common side effect of chemotherapy. Almost everyone who has chemotherapy will experience fatigue. You may feel generally tired or you may tire very easily after doing normal, everyday tasks.
While having chemotherapy, it is important to get plenty of rest. Do not carry out tasks or activities that you do not feel up to.
Light exercise, such as walking or yoga, can help boost your energy levels, but be careful not to push your body too hard.
If you are working, you may need to ask your employer to let you work part time until your chemotherapy has finished.
Contact your Dr. B C Shah if you are suddenly significantly more tired than usual and you also feel out of breath. Extreme fatigue and shortness of breath can be a sign of anaemia. This is a condition caused by having a low number of red blood cells.
Nausea and vomiting
Nausea (feeling sick) and vomiting (being sick) are common side effects of chemotherapy. They affect around half of all people being treated.
If you have nausea and vomiting, you will be given medication to help control your symptoms. This type of medication is known as an anti-emetic.
Anti-emetics can be given in a number of different ways, including:
as a tablet or capsule, which can either be swallowed or placed under your tongue to dissolve
as an injection or drip
as a suppository, which is a capsule that you put into your rectum (back passage) so that it can dissolve
through a patch that you place on your skin
Continue to take your anti-emetics even if you do not feel sick because they will help prevent your symptoms from returning.
Side effects of anti-emetics include:
Constipation
Flushing of the skin
Problems sleeping (insomnia)
Indigestion
Headaches
There are several different types of anti-emetics. If the one you are taking doesn't work or if it causes too many troublesome side effects, contact Dr. B C Shah. There may be an alternative anti-emetic that works better for you.
Hair loss
Hair loss is a common side effect of some chemotherapy. It usually begins one to three weeks after the first chemotherapy dose. The hair that grows on the side of your head, near your ears, becomes more brittle and thin. Most people have significant hair loss after one to two months.
The scalp is most commonly affected, although hair loss can occur on other parts of the body. These include the arms, legs and face.
Hair loss can be very traumatic, particularly for women.
If you find hair loss particularly difficult to cope with, talk to Dr. B C Shah. They understand how distressing it can be and will be able to give you support and counselling.
You may decide that you want to wear a wig.
Hair loss due to chemotherapy is almost always temporary, and your hair should begin to grow back soon after your treatment has finished.
Around three-quarters of people no longer need to wear a wig or use a head covering six months after their chemotherapy treatment has finished.
Many people find that their newly grown hair is different than before. For example, it may be a different colour or it may be curlier or straighter than it used to be.
Cold cap
It may be possible to prevent hair loss due to chemotherapy by using a cold cap.
A cold cap looks similar to a bicycle helmet. It is designed to cool your scalp while you receive a dose of chemotherapy. In cooling the scalp, the cold cap reduces the amount of blood flow to the scalp. This reduces the amount of chemotherapy medication that reaches it.
Whether or not you can use a cold cap during treatment will depend on the type of cancer you have.
For example, a cold cap cannot be used if you have:
various types of leukaemia, such as acute lymphoblastic leukaemia, which is cancer of the blood cells and mainly affects children
multiple myeloma, which is a cancer that develops inside the bone marrow
non-Hodgkin's lymphoma, which is a cancer that develops inside the lymphatic system (a series of glands and vessels that help protect the body against infection)
With these types of cancers, there is a good chance that cancerous cells could have spread to your skull. Therefore, it would be too dangerous to cool your skull.
Cold caps work better with certain types of chemotherapy medications, and they may not always prevent hair loss.
Increased risk of infection
Chemotherapy lowers the amount of white blood cells in your body. The main function of white blood cells is to fight infection. If the number of white blood cells is reduced, your immune system will be weakened and you will be more vulnerable to infection.
You may be given a course of antibiotics to reduce your risk of developing an infection. You will also need to take extra precautions to protect yourself against infection. For example, you should:
Have good personal hygiene – take daily baths or showers and make sure that clothes, towels and bed linen are washed regularly.
Avoid contact with people who have an infection, such as chickenpox or flu.
Wash your hands regularly with soap and hot water, particularly after going to the toilet and before preparing food and eating meals.
Take extra care not to cut or graze your skin – if you do, clean the area thoroughly with warm water, dry it and cover it with a sterile dressing.
The regular blood count tests that you will have during chemotherapy mean that your Dr. B C Shah should be able to tell you when you are most vulnerable to infection.
You may be advised to take extra precautions, such as avoiding crowded places and using public transport at busy times.
Anaemia
Chemotherapy will lower the amount of red blood cells. These cells carry oxygen around the body. If your red blood cell count drops too low, your body will be deprived of oxygen and you will develop anaemia.
Symptoms of anaemia include:
tiredness – you will feel much more tired than the general level of fatigue associated with chemotherapy
lack of energy
shortness of breath (dyspnoea)
irregular heartbeat
If you have any of these symptoms, contact your Dr. B C Shah as soon as possible.
You may need to have a blood transfusion to help increase the number of red blood cells. Alternatively, a medication called erythropoietin (EPO) can stimulate the production of red blood cells.
It is important to eat a diet that is high in iron. This is because iron helps red blood cells carry more oxygen. Foods that are high in iron include:
dark-green leafy vegetables, such as spinach
iron-fortified bread
beans
nuts
meat
apricots
prunes
raisins
Bruising and bleeding
Chemotherapy can lower the amount of platelets in your body. Platelets are blood cells that help blood to clot (thicken). This prevents excessive bleeding or bruising.
Most chemotherapy medications do not seriously affect the number of platelets. However, a small number of people experience a significant drop in their platelet count.
Symptoms of a low platelet count include:
easily bruised skin
nose bleeds
bleeding gums
Report any of these symptoms to Dr. B C Shah as you may need a blood transfusion to raise your platelet count.
You may need to take extra precautions to avoid damaging your skin and gums including:
using an electric razor to shave
using a soft toothbrush
taking extra care when using knives or other sharp instruments
wearing a thick pair of gloves when gardening
Oral mucositis
In some cases, chemotherapy can cause pain and inflammation of the surface of the inside of your mouth. This is known as oral mucositis.
The severity of your symptoms usually depends on the strength of your medication. People having high-dose chemotherapy usually have more severe symptoms.
The symptoms of oral mucositis usually begin 7 to 10 days after you start chemotherapy.
If you develop oral mucositis, the inside of your mouth will feel sore, as if you have burnt it by eating very hot food. You will probably develop ulcers on the lining of your mouth and, in some cases, on your tongue or around your lips.
The ulcers can be very painful and make it difficult to eat, drink and talk. They may also bleed and become infected.
The symptoms of oral mucositis should clear up a few weeks after your chemotherapy finishes, although a number of medications are available to relieve the symptoms.
Loss of appetite
Some people who have chemotherapy lose their appetite and do not feel like eating or drinking. If you lose your appetite, it is still important to make an effort to eat healthily and drink plenty of liquids.
You may find eating smaller, more frequent meals better than eating three large meals a day. Try sipping drinks slowly through a straw rather than drinking them straight from a glass.
If you have serious problems eating and drinking due to symptoms such as mouth ulcers, you may need to be admitted to hospital and attached to a feeding tube.
You will probably be given a nasogastric tube. This is a tube that passes down your nose and into your stomach. The tube can be removed once you are able to eat and drink normally.
Skin
Some chemotherapy medications can cause your skin to become dry and sore, particularly on your hands or feet. Your nails may become brittle and flakier than usual and white lines may develop across them.
During chemotherapy and for some time after treatment has finished, your skin may become more sensitive to sunlight. Therefore, it is important to take extra precautions to protect your skin from the sun:
Avoid going out in the sun when it is at its hottest – this is usually between 10am and 2pm, although the sun can also damage skin before and after these times.
Use a sunscreen that blocks both ultraviolet A (UVA) and B (UVB) radiation and has a sun protection factor (SPF) of at least 15.
Dress to protect your skin from the sun – for example, wear a wide-brimmed hat to protect your face and scalp and sunglasses to protect your eyes.
Memory and concentration
Some people who have chemotherapy have problems with their short-term memory, concentration and attention span. You may find that routine tasks take much longer than usual.
Exactly why these symptoms appear is unclear. They may be due to a combination of factors, such as fatigue and anxiety. However, the symptoms usually improve after your treatment has finished.
Sleep problems
Sleep problems are a common side effect of chemotherapy. They are thought to affect around half of all people being treated with chemotherapy.
Sleep problems can include difficulty falling asleep (insomnia), and waking up in the middle of the night and being unable to get back to sleep.
The following advice may help to improve your sleep:
Go to bed only when you are sleepy.
If you cannot sleep, leave the bedroom and only return when you feel sleepy.
Only use your bedroom for sleeping and having sex.
Avoid napping during the day. If this is not possible, try to limit your naps to about half an hour.
Avoid stimulants, such as caffeine, for at least six hours before you plan to go to bed.
If this advice does not work, contact your Dr.B C Shah. You may need additional treatment. A type of talking therapy called cognitive behavioural therapy (CBT) has proved to be effective in treating insomnia associated with chemotherapy.
Sexuality and fertility
Many people find that their interest in sex decreases during chemotherapy. However, this is usually temporary and your interest in sex should gradually return after your treatment has finished.
Some chemotherapy medications can stop women being able to conceive and can prevent men from producing healthy sperm. Loss of fertility is usually temporary, although in some cases a person can become permanently infertile.
If there is a risk that you could become permanently infertile, your Dr. B C Shah will discuss the possibility with you before treatment begins.
A number of options are available. Women can have their eggs frozen to be used later in IVF (in-vitro fertilisation). Men can have a sample of their sperm frozen to be used at a later date for artificial insemination.
Diarrhoea and constipation
You may have diarrhoea or constipation a few days after you begin chemotherapy. Dr. B C Shah can recommend suitable medication to help control the symptoms.
Depression
Living with the effects of chemotherapy can be frustrating, stressful and traumatic. It is natural to feel ongoing anxiety and concern about whether your treatment will be successful.
Stress and anxiety can increase your risk of getting depression. You may be depressed if you have been feeling particularly down for two weeks or more and you no longer take pleasure in the things that you used to enjoy.
Contact Dr. B C Shah if you have psychological and emotional difficulties. They will be able to recommend treatments to help improve the symptoms of stress, anxiety and depression.
Joining a support group for people who are having chemotherapy may also help. Talking to other people in a similar situation can often reduce feelings of isolation and stress.
Refusing or withdrawing treatment
In some circumstances, you may think that the benefits of chemotherapy are not worth the poor quality of life due to the side effects of treatment.
For example, if chemotherapy offered no hope of a cure and could only extend your life by a few months, you may feel that the extra few months are not worth undergoing treatment.
However, if you were looking forward to an event such as the birth of a grandchild or the wedding of a son or daughter, you may want to extend your life whatever the cost to your wellbeing.
There is no right answer or recommendation about when chemotherapy should be refused or withdrawn. Dr. B C Shah can give you advice about the likely benefit of continuing with treatment, but the final decision will be yours.
This is obviously a very sensitive topic that you should discuss fully with Dr. B C Shah, family, friends and loved ones. You always have the right to refuse a particular treatment or to ask for the treatment to be stopped if you do not feel it is benefiting you.
Stopping chemotherapy does not mean that any symptoms you have will go untreated. Dr. B C Shah will still provide support and pain relief. This type of care is known as palliative care.
If it's thought that you do not have long to live, it may be recommended that you are admitted to a hospice. Hospices provide care for people from the point at which their illness is diagnosed as terminal to the end of their life, however long that may be.

Introduction
Radiotherapy, also known as radiation treatment, is the controlled use of high energy X-rays to treat many different types of cancer. About 4 out of 10 people with cancer have radiotherapy.
In some cases, radiotherapy can also be used to treat benign (non-cancerous) tumours.
The length of each course of radiotherapy will depend on the size and type of cancer and where it is in the body.
Uses of radiotherapy
Radiotherapy may be used:
To cure an illness - for example, by destroying a tumour (abnormal tissue)
To control symptoms - for example, to relieve pain
Before surgery - to shrink a tumour to make it easier to remove
After surgery - to destroy small amounts of tumour that may be left
Radiotherapy is sometimes used to treat thyroid disease, as well as some blood disorders and other benign conditions. This topic focuses mainly on the use of radiotherapy as a treatment for cancer.
Types of radiotherapy
Radiotherapy can be given in two ways. It can be given from:
Outside the body (external radiotherapy) – using X-rays, small particles called electrons or, in rare cases, other particles such as protons; external radiotherapy is usually given once a day as a course of treatment over a number of days or weeks
Within the body (internal radiotherapy, also known as brachytherapy) – either by drinking a liquid that is absorbed by the cancerous cells or by putting radioactive material into, or close to, the tumour, usually for a small number of treatments (brachytherapy) or by injecting or drinking a liquid that is absorbed by the cancerous cells – for example, radioiodine for thyroid cancer
Courses of radiation
Radiotherapy is usually given as a course of treatment that lasts for a number of days or weeks.
Most people who have radiotherapy to treat a serious condition, such as cancer, have five treatments a week (one treatment a day, Monday to Friday) with a break at the weekend. Taking a break allows the normal, non-cancerous cells to recover.
In some cases, treatment may be given more than once a day or over the weekend.
Fractions
Radiation treatment is divided into a number of small doses called fractions, which are usually given over a number of weeks. Fractions are used to reduce the side effects of a full dose of radiation. The number of fractions required will depend on the type of cancer being treated.
Combination therapy
Radiotherapy is often used in combination with other treatments, such as chemotherapy (powerful medication that is used to treat cancer). This is known as chemoradiotherapy.
Chemoradiotherapy can be used to try to cure a cancerous tumour, to shrink a tumour before it is removed using surgery, or after surgery to reduce the risk of relapse.
How radiotherapy works
External radiotherapy
During external radiotherapy, a machine called a linear accelerator focuses high-energy X-rays or other high-energy beams at the cancer. Radiation kills the cancerous cells but also causes temporary damage to healthy, non-cancerous cells, resulting in side effects, most of which are temporary because normal tissues are able to repair themselves.

If radiotherapy is recommended, you will be referred to a specialist radiotherapy (oncology) department where you will receive your treatment. The type of machine that is used will depend on the reason for your treatment and the condition that you are being treated for.
You will not feel any pain during the treatment, but later you may experience some discomfort from the side effects of the treatment. Most side effects do not usually last long.
Internal radiotherapy
Internal radiotherapy uses radioactive materials (metal implants or liquids) to treat cancer. The two types of radioactive material are described below.
Radioactive implants (brachytherapy)
Radioactive implants are usually metal wires, seeds or tubes. They are inserted into or close to the cancerous tumour in a procedure that is known as brachytherapy.
The length of time that the radioactive implant is left inside your body will depend on the type and nature of your cancer. It could be a few minutes or a few days. In some cases, radioactive implants may be left inside the body permanently.
Radioactive metals, such as caesium and iridium, are sometimes used to treat prostate cancer, cancer of the womb, cervical cancer and vaginal cancer.
Radioactive liquids
Radioactive liquids to treat cancer are given either as a drink or an injection. The radioactive part of the liquid is known as an ‘isotope’.
Radioactive liquids include:
Phosphorous - which is used to treat blood disorders
Strontium - which is used to treat secondary bone cancers
Iodine - which is used to treat benign (non-cancerous) thyroid conditions and thyroid cancer
Safety
Health risks associated with radiotherapy are usually minimal because the radiation dose received by the rest of the body is usually very low.
However, as internal radiotherapy involves placing radioactive substances inside your body, there are some safety issues that you will need to discuss with your treatment team.
How radiotherapy is performed
Radiotherapy is only used if the benefits outweigh the risks. Your treatment team will discuss the risks of any radiotherapy procedures that are recommended for you.
Before having radiotherapy, you will be asked to sign a consent form to confirm that you agree to the treatment and understand any risks involved.
Treatment plan
Your treatment will be carefully planned to ensure that the radiotherapy destroys as many cancerous cells as possible, while affecting as few healthy cells as possible.
The amount of radiotherapy you have will depend on:
Where the cancer is in your body
The type and size of the cancer
Your general state of health
In planning your treatment, a radiotherapist (radiotherapy specialist or clinical oncologist) will use all the information gathered during your diagnosis. They may also carry out some additional tests to find out more about the size and site of the cancer and to get a clearer understanding of the area of your body to be treated.
Once your oncologist has all the relevant information, they will calculate the total dose of radiotherapy that you need and the number of individual doses (fractions) required.
If you are having external radiotherapy, a simulator machine will be used as part of your treatment planning. The simulator moves in the same way as the machine that will be used for your treatment. It uses X-rays to take pictures so that the radiographer knows how to position your body when you have your treatment. A radiographer is a healthcare professional who is trained in taking X-rays.
Many patients will also have a computerised tomography scan (CT) scan to help the oncologist to target their tumour accurately.
After the exact area of your body to be treated has been established, the radiographer will put small but permanent ink marks on your skin to ensure that the same area is treated each time.
If you are having external radiotherapy to your head or neck, or if it is difficult for you to keep the part of your body having treatment still, a plastic mould will be made for you to wear during treatment. In this case, the ink markings will be made on the mould rather than on your skin.
External radiotherapy
If you are having external radiotherapy, you will usually receive your treatment as an outpatient, which means that you will not have to stay in hospital overnight. You may need to stay in hospital if you are having chemotherapy in combination with radiotherapy (chemoradiotherapy), or if you are unwell.
During the procedure, you will be positioned on a treatment table and a radiotherapy machine (linear accelerator) will direct high-energy rays at the area being treated.
You will need to keep as still as possible throughout the treatment. The procedure only takes a few minutes and is completely painless. You will be able to breathe normally during your treatment.
While you are having treatment, you will be left alone in the treatment room. A radiographer will operate the machine from outside the room and will watch you through a window or on closed circuit television. If necessary, you will be able to talk to the radiographer during the procedure using an intercom.
Internal radiotherapy
Internal radiotherapy can be given as an implant, drink or injection. Depending on the type of treatment being used, you may need to stay in hospital for a short period of time.
Radioactive implants
If you have a radioactive implant or radioactive liquid, your hospital will have a number of safety guidelines in place to ensure that hospital staff and visitors are not exposed to radiation. Hospital staff will explain the safety procedures to you before your treatment.
Radioactive implants are placed into, or next to, the cancerous tumour so that it gets the highest possible dose of radiation. Although the area close to the implant will also get a high dose of radiation, other parts of your body will receive a very small amount of radiation which is not a risk to your health.
If you are having a radioactive implant, you may need to stay in hospital for a few days until the radioactive source is removed. After the implant has been removed, you are not a risk to others.
Permanent implants do not present a risk because they produce a very small amount of radiation that gradually decreases over time.
Liquid radiotherapy
After having liquid radiotherapy, you may be radioactive for a few days. This will not cause any long-term harm to your body, but you will probably have to stay in hospital until the radioactivity decreases. This is a precautionary measure to reduce other people’s exposure to radiation.
You will be able to leave hospital after the radiation has fallen to a safe level. Dr. B C Shah may give you some safety advice to follow for a few days when you get home.
If there is anything about your treatment that you do not understand, or if there is anything you are unsure about, you should ask a member of your treatment team to explain it to you in more detail.
Common side effects of radiotherapy
Following radiotherapy, it is highly likely that you will have some side effects. Side effects occur because radiotherapy temporarily damages some of the healthy cells as well as destroying the cancerous ones.
Side effects will depend on:
The part of your body being treated
The dose of radiotherapy
How quickly the healthy cells are able to repair the damage
Radiotherapy affects different people in different ways and it is difficult to know exactly how you will react to the treatment.
Some people experience mild side effects following radiotherapy, while others experience more severe effects. Some side effects begin during treatment whereas others can appear weeks or months afterwards.
Before starting treatment, you should discuss the possible side effects with your treatment team.
Common side effects of radiotherapy include:
Sore skin
Tiredness
Feeling sick
Dry mouth
Loss of appetite
Diarrhoea
Dair loss
discomfort on swallowing
a lack of interest in sex
stiff joints and muscles
These are explained in more detail below.
Sore skin
Your skin may become red and sore in the area being treated towards the end of a course of radiotherapy, or for a couple of weeks afterwards.
Depending on the area being treated, and the individual’s reaction to radiation, some people’s skin may peel after having a course of radiotherapy. This usually heals within a couple of weeks.
Dr. B C Shah will be able to give you advice about the best way of caring for your skin during treatment. If your skin becomes sore, you should try not to irritate it further.
You should avoid shaving and using perfumed soap in the affected area. Protect your skin from cold winds and wear a high-factor sunscreen (SPF 15 or above) to protect your skin from the sun.
Tiredness
You will probably feel tired both during and after having radiotherapy. Doing some gentle exercise may help to relieve the symptoms of tiredness.
Tiredness is particularly common towards the end of a course of radiotherapy and it can last for some time afterwards. It usually occurs as a result of the body repairing the damage to healthy cells.
A shortage of red blood cells (anaemia) can also contribute to tiredness during radiotherapy.
For some cancers, regular blood tests may be required during radiotherapy to ensure that you are not becoming anaemic. If you have anaemia, you may need to have a blood transfusion (where you receive blood that is removed from another person who is known as a donor).
Feeling sick (nausea)
Most people are not sick during radiotherapy. However, some people feel sick (are nauseated) at the start of, during, or for a short time after, their treatment. If you experience nausea, your doctor may be able to prescribe medication to help control it.
Radiotherapy to your abdomen (tummy area) or pelvic area may make you sick. This can last a few days after your treatment stops. Again, medication or complementary therapies can help.
Loss of appetite
The combination of feeling sick and tired during radiotherapy can make you lose your appetite. You may have difficulty swallowing if you are having radiotherapy to your head, neck or chest.
If you have difficulty eating, you may find it easier to eat several small meals throughout the day, rather than a few larger meals. You can also speak to your radiotherapist who may refer you to a dietitian (nutritional specialist).
Diarrhoea
Diarrhoea is a common side effect of radiotherapy to the abdomen or pelvic area. It usually starts a few days after treatment begins and gradually gets worse as treatment continues. You should tell your doctor if you notice any blood in your stools (faeces).
After your treatment has finished, diarrhoea should disappear within a few weeks. You should tell your doctor if your symptoms have not improved after a few weeks.
Hair loss
Hair loss is a common side effect of radiotherapy to your head or neck. Radiotherapy will only cause hair loss in the area being treated.
Many people find losing their hair stressful and difficult to cope with. Losing your hair can affect your self-confidence and it may make you feel depressed.
Talk to your family and friends about how you are feeling so that they can support you. After a few weeks of finishing treatment, your hair should start to grow back.
You may consider getting a synthetic (man-made) wig or a wig that is made from human hair.
Inpatients (those who need to stay in hospital overnight for treatment)
Those under 16 years of age
Those between 16 and 19 years of age who are in full-time education
Discomfort on swallowing
Radiotherapy to the chest can cause the tube through which food passes (the oesophagus) to become temporarily inflamed, which may cause temporary discomfort when swallowing. If required, Dr. B C Shah will be able to prescribe medication to help soothe your throat.
Effects on sex and fertility in women
Having radiotherapy may cause you to lose interest in sex, particularly if you have other side effects, such as tiredness or nausea, or if you are anxious about your condition or treatment.
You should avoid eating hot or spicy food and drinking acidic drinks or spirits during this time because they can aggravate the problem.
Radiotherapy to the vaginal area may cause your vagina to become sore and narrower. Your radiotherapist will tell you how you can treat this using a vaginal dilator, which is a device that is inserted into your vagina to help prevent it narrowing. Having sex regularly after your treatment can also help prevent your vagina narrowing.
If you experience vaginal dryness or pain when having sex, you can use lubricants or Dr. B C Shah to prescribe appropriate medication. Radiotherapy to other areas of the body will not affect your ovaries or make you infertile.
Effects on sex and fertility in men
In men, temporary erectile dysfunction (the inability to get and maintain an erection) and loss of interest in sex are common side effects of pelvic radiotherapy.
Radiotherapy to other areas of your body will not make you infertile or cause any problems if you decide to have children in the future.
If there is a risk that you could become infertile following radiotherapy, your doctor will discuss this with you before your treatment.
Stiff joints and muscles
Radiotherapy can sometimes cause your muscles to tighten up and your joints to become stiff in the area being treated. You may also experience some uncomfortable swelling in the affected area.
Exercising your joints and muscles regularly can help prevent stiffness. If you have stiff joints and muscles, your doctor or radiotherapist may refer you to a physiotherapist, who will be able to recommend suitable exercises for you.
Long-term side effects of radiotherapy
It is rare to develop severe, long-term side effects as a result of having radiotherapy. Your doctor will discuss the likelihood that you will experience side effects before you consent to treatment.
Sometimes, side effects can occur years after finishing a course of radiotherapy. Some of these may be permanent and can include:
Effects on fertility
Cosmetic changes to the skin
Tiny cracks in your pelvic bones (pelvic insufficiency fractures)
An inability to control your bowel (bowel incontinence)
Swelling in your arms or legs (lymphoedema)
These are discussed in more detail below.
Infertility and early menopause
In women, radiotherapy to the pelvic area exposes the ovaries to radiation. In pre-menopausal women, this may cause early menopause (where a woman's monthly periods stop) and infertility (the inability to get pregnant). This is often very upsetting, particularly for younger women who want to have a family.
Before having treatment, your doctor will discuss all the options and available support with you. For example, it may be possible for some of your eggs to be surgically removed, frozen and stored until you are ready to have a baby.
Cosmetic changes to the skin
Long-term changes to the skin can occur after having radiotherapy. Some people notice that their skin is thicker, a slightly darker colour and, occasionally, dimpled (like the peel of an orange). These changes usually improve over time.
Pelvic insufficiency fractures
Radiotherapy to your pelvic bones can cause tiny cracks, known as pelvic insufficiency fractures, to appear in the bones of your pelvis some time after treatment has finished. Pelvic insufficiency fractures are more likely to occur in people who have osteoporosis, a condition that causes brittle bones.
Pelvic insufficiency fractures can be very painful, particularly during exercise. Resting should help to reduce the pain. You should report any new bone pain that you experience to your oncologist or GP.
Bowel incontinence
Bowel incontinence, sometimes known as faecal incontinence, is a rare side effect of radiotherapy to the pelvis. It is the inability to control your bowel movements which can result in faeces (stools) leaking from your rectum (back passage).
Bowel incontinence can be treated with dietary changes, medicines or a number of different surgical procedures.
Lymphoedema
Radiotherapy can damage your body’s network of channels and glands that make up the lymphatic system. One of the functions of the lymphatic system is to drain excess fluid from your tissues. If the lymphatic system is damaged, fluid can build up and cause swelling and pain.
This is known as lymphoedema and it often occurs in the arms or legs although it can also affect other areas, such as the chest. Lymphoedema is usually associated with women who have had radiotherapy for breast cancer.
It may be possible to prevent lymphoedema occurring using appropriate skincare techniques and exercise.
Recovering from radiotherapy
Most side effects of radiotherapy only last for a few days or weeks after treatment has finished. However, some side effects, such as tiredness or hair loss, can last for a few months.
Follow-up appointments
After your course of radiotherapy has finished, you will have an appointment with your oncologist (a cancer doctor who specialises in radiotherapy) to check on your progress.
You may need to have follow-up appointments for several years, but they will usually become less frequent as time passes.
Dr. B C Shah will be sent a report about your treatment. You will also be able to contact a member of your treatment team if you have any questions after your course of radiotherapy has finished.
Effects of radiotherapy
Despite the side effects mentioned here, radiotherapy can be a highly effective treatment, either in curing or controlling a cancer, or relieving symptoms.
The positive effects of radiotherapy usually take some time to become apparent. The treatment's benefits will depend on the type of cancer that you have and how advanced it is when treatment begins.
The effectiveness of your radiotherapy treatment may also depend on whether you are having other forms of treatment alongside radiotherapy, such as chemotherapy or surgery.

Introduction
Cystitis is inflammation of the bladder. It's usually caused by an infection in the bladder, but can also be caused by irritation or damage (from friction during sex, for example).
Symptoms of cystitis are:
An urgent need to urinate often
Pain or stinging when you urinate
Cystitis usually passes within a few days, or sometimes may need treatment with antibiotics.
Untreated bladder infections can cause kidney infections.
Cystitis in women
Cystitis is more common in women because women have a short urethra (the tube that carries urine from the bladder out of the body). The urethra's opening is also located very close to the anus (bottom), which makes it easy for bacteria from the anus to reach the bladder and cause an infection.
Almost all women will have cystitis at least once in their lifetime. Around one in five women who have had cystitis will get it again (known as recurrent cystitis). Cystitis can occur at any age, but it is more common in:
Pregnant women
Sexually active women
Post-menopausal women (women who have been through menopause)
Cystitis in men
Cystitis is less common in men. It can be more serious in men because it could be caused by:
An underlying bladder or prostate infection, such as prostatitis
An obstruction in the urinary tract, such as a tumour, or an enlarged prostate (the gland located between the penis and the bladder)
Male cystitis is not usually serious if treated quickly, but it can be very painful. Sexually active gay men are more likely to get cystitis than other males.
Outlook
Mild cystitis usually clears up within 4-9 days. You can treat it at home by drinking plenty of water (around 1.2 litres or 6-8 glasses every day) and taking painkillers, such as paracetamol or ibuprofen. More severe cystitis can also cause abdominal pain or fever, and may need treatment with antibiotics.
Seeing Dr. B C Shah
Children and men should always see Dr. B C Shah if they have symptoms of cystitis. Women should always see Dr. B C Shah the first time they have the symptoms of cystitis. They should also return to him if they have the condition ore than three times in one year.
Symptoms of cystitis
Children and adults can get cystitis, and the symptoms can be different.
Symptoms in men and women
Cystitis in men and women can cause:
Pain, burning or stinging when you urinate
Needing to urinate often and urgently but passing only small amounts of urine
Urine that's dark, cloudy or strong smelling
Urine that contains traces of blood (haematuria)
Pain low in your belly (directly above the pubic bone), or in the lower back or abdomen
Feeling unwell, weak or feverish
Symptoms in children
Symptoms of cystitis in children may include:
Weakness
Irritability
Reduced appetite
Vomiting
Pain when urinating
Cystitis is usually treated easily.
Seeing Dr. B C Shah
The usual symptoms of cystitis could also be caused by other conditions, so it's important to see Dr. B C Shah the first time you have any of these symptoms. This means you can be treated correctly for whatever is causing your symptoms.
The symptoms caused by cystitis could also be caused by:
Sexually transmitted infections (STIs), such as gonorrhoea or chlamydia
Being infected with bacterium such as E-coli
Vaginal thrush, also known as candida (a yeast infection)
Inflammation of the urethra (urethritis)
Urethral syndrome (women only)
Inflammation of the prostate gland, also known as prostatitis (men only)
Causes of cystitis
The most common cause of cystitis is a bacterial infection. If bacteria reach the bladder, they can multiply and irritate the bladder lining, causing the symptoms of cystitis.
Cystitis can also result from damage or irritation around the urethra. The urethra is the tube that carries urine from the bladder out of the body. In men, the urethral opening (where urine leaves the body) is at the tip of the penis. In women it's just below the clitoris.
Bacterial infection
This happens when bacteria get into the bladder and multiply. It can happen if you don't empty your bladder properly. Try to empty your bladder fully each time you go to the toilet, to help prevent bacterial infection.
You may not be able to empty your bladder fully if:
You have a blockage somewhere in your urinary system: this could be caused by a tumour or, in men, an enlarged prostate (a gland located between the penis and the bladder)
You are pregnant, as pregnancy puts pressure on the pelvic area and the bladder
Bacterial infection can also happen when bacteria from the anus are transferred to the urethra. This is more common in women than in men, as the urethra is closer to the anus in women than it is in men.
In women, transferring bacteria in this way can happen when you are:
Having sex
Wiping after going to the toilet (you're less likely to transfer bacteria in this way if you wipe from front to back)
Inserting a tampon
Using a diaphragm (a soft dome made of latex or silicone) for contraception
In women who have had, or are going through, the menopause, the lining of the urethra and the bladder become thinner. This is due to a lack of the hormone oestrogen. The thin lining is more likely to become infected or damaged. Women also produce fewer vaginal secretions after the menopause, which means that bacteria are more likely to multiply.
Damage or irritation
Cystitis can also be caused by damage or irritation in the area around the urethra in both men and women. This could be the result of:
Damage or bruising caused by vigorous or frequent sex (this is sometimes called honeymoon cystitis)
Wearing tight clothing
Chemical irritants – for example, in perfumed soap or talcum powder
Other bladder or kidney problems, such as a kidney infection or prostatitis
Diabetes (a long-term condition caused by too much glucose in the blood)
Damage caused by a catheter (a tube inserted into the urethra to allow urine to flow into a drainage bag, which is often used after surgery)
Diagnosing cystitis
If you have had cystitis before, you may be able to recognise the symptoms and diagnose the condition yourself.
However, men and children with cystitis symptoms should always see Dr. B C Shah. Men, women and children should see Dr. B C Shah if:
This is the first time you've had cystitis symptoms
There's blood in your urine (haematuria)
You have a high temperature (fever) of 38ºC (100.4ºF)
You're in a lot of pain
You've had cystitis three times in one year
Dr. B C Shah should be able to diagnose cystitis from asking about your symptoms. In some cases, they may also use a dipstick (a chemically treated strip of paper) to test a sample of your urine. The paper will react to certain bacteria by changing colour, showing which kind of infection you have.
Urine culture
Dr. B C Shah may wish to send a sample of your urine to a laboratory for further testing. This sample is called a urine culture. This may be necessary if:
you have recurrent cystitis (more than three times in one year)
it is possible that you may have a kidney infection – cystitis can be a symptom of this
you are on immunosuppressant medication(medication that suppresses your immune system) – these affect your body’s defences so you may be more prone to infection
you have diabetes (a long-term condition caused by too much glucose in the blood) – cystitis can be a complication of diabetes
you may have a sexually transmitted infection(STI) – such as gonorrhoea and chlamydia
it is possible that you have another infection, such as thrush (candida)
The urine culture will confirm which bacteria are causing your cystitis. Alternatively, it may reveal that your cystitis is caused by another condition. Dr. B C Shah can advise you about the most appropriate treatment for you.
Further tests
If you have recurrent cystitis that does not respond to antibiotics, even after a urine culture has been tested,you may need to have some other tests, such as:
An ultrasound scan
An X-ray
A cystoscopy
A cystoscopy is when a tiny fibre-optic camera, called a cystoscope, is used to examine your bladder. The cystoscope is a very thin tube that has a light and a camera at one end. It is inserted into your urethra (the tube that carries urine from your bladder out of your body) and transmits images of the inside of your bladder to a screen.
Any further tests that you need will be explained to you by Dr. B C Shah treating you.
Treating cystitis
Children and men should always see Dr. B C Shah if they have cystitis symptoms. Women should always see Dr. B C Shah the first time they have cystitis symptoms, and also if they have the condition more than three times in one year.
The symptoms of cystitis usually clear up without treatment within 4-9 days. There are some self-help treatments that can ease the discomfort of any symptoms, or Dr. B C Shah may prescribe antibiotics.
Self-help treatments
If you've had cystitis before and you're sure that you have mild cystitis and don't need to see Dr. B C Shah, there are treatments that you can try yourself.
Over-the-counter (OTC) painkillers, such as paracetamol or ibuprofen. These can reduce pain and discomfort. Always read the label and check with your pharmacist first, particularly if you have any other medical condition, you are taking other medicines, or you're pregnant or breastfeeding.
Drinking plenty of water is often recommended as a treatment for cystitis. There's no evidence that this is helpful, although drinking around 1.2 litres (6-8 glasses) of water a day is generally good for your health. Also avoid alcohol.
Don't have sex until your cystitis has cleared up because having sex can make it worse.
Some people find that using urine alkanising agents, such as sodium bicarbonate or potassium citrate, for a short period of time may help to relieve pain when urinating. However, there is currently a lack of clinical evidence for their effectiveness. Check with Dr. B C Shah first if you are taking any other medication.
Drinking cranberry juice is not thought to help relieve pain but may help to prevent outbreaks of recurrent cystitis.
Antibiotics
If your symptoms are moderate or severe, Dr. B C Shah may prescribe a short course of antibiotics. This will usually involve taking a tablet 2-4 times a day, for three days.
For a more complicated case of cystitis, such as cystitis with another underlying infection, you may be given antibiotics for 5-10 days.
If your cystitis symptoms are only mild, Dr. B C Shah may prefer not to prescribe antibiotics to avoid ‘antibiotic resistance’. This is when the bacteria that cause cystitis adapt and learn to survive the antibiotics. Over time, this means that the treatment becomes less effective.
Recurring cystitis
If you keep getting cystitis (known as having recurring cystitis) your doctor may prescribe stand-by antibiotics or continuous antibiotics. A stand-by antibiotic is a prescription for you to take the next time you have cystitis, without needing to visit Dr. B C Shah again.
Continuous antibiotics are antibiotics that you take for several months to prevent further episodes of cystitis. These may be prescribed for two reasons:
If your cystitis usually occurs after having sex, you may be given a prescription for antibiotics to take within two hours of having sex
If your cystitis is not related to having sex, you may be given a low-dose antibiotic to take for a trial period of six months
Complications
Most cases of cystitis clear up on their own or with antibiotics. However, untreated bladder infections can cause kidney infections, which can be serious.
Although cystitis usually clears up on its own or with antibiotics, some people experience almost constant symptoms or recurring episodes. If no cause can be found, and the cystitis doesn't respond to antibiotics, you may have interstitial cystitis.
Interstitial cystitis
Interstitial cystitis causes recurring discomfort in the bladder and pelvic area. Like cystitis, it can cause an urgent and frequent need to urinate. Other symptoms, and the level of pain it causes, can vary from person to person.
Some people may find it more painful when their bladder is full, or more painful when they urinate. Women may find the condition more painful during their period.
How is it treated?
Treatment can include:
Medications, including painkillers and antidepressants
Bladder distension – when the bladder is filled with water to increase its volume
Bladder instillation – the bladder is filled with a solution that includes medication to reduce inflammation of the bladder walls
Surgery, if other treatments haven't worked
If you're diagnosed with interstitial cystitis, Dr. B C Shah will explain the condition and the treatment options in more detail.
Dr. B C Shah may use the term 'painful bladder syndrome' (PBS) to describe a condition that causes pain but doesn't meet the criteria to be diagnosed as interstitial cystitis.
Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Painkillers
Painkillers (analgesics) are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.
Preventing cystitis
It's not always possible to prevent cystitis, but you can take some steps to help avoid the condition:
Don't use perfumed bubble bath, soap, or talcum powder around your genitals – use plain, unperfumed varieties
Have a shower, rather than a bath, to avoid exposing your genitals to the chemicals in your cleaning products for too long
Always empty your bladder fully when you go to the toilet
Don't wait to go if you need to urinate: delaying it can place extra stress on your bladder and could make it more vulnerable to infection
Wear underwear made from cotton rather than synthetic material such as nylon
Avoid wearing tight jeans and trousers
Always wipe from the front of your genital area to the back, not back to front, when you go to the toilet
Some people find certain types of food and drink make their cystitis worse: for example, coffee, fruit juice or spicy foods. If there is anything that triggers your cystitis, you may wish to avoid it
Cranberry products
Although cranberry products are not effective at treating cystitis, they may help to prevent recurrent attacks. High-strength capsules, which contain 200mg of cranberry extract, are available in shops .
Cranberry capsules may be a more effective treatment than drinking cranberry juice, as you need to drink a lot of juice for it to benefit you, and not everyone likes the taste. Cranberry capsules are not recommended if you are taking warfarin (blood-thinning medication).
Cystitis and sex
Try these tips if your cystitis is triggered by having sex:
Wash your genital area and your hands before and after sex
Use a lubricant during sex to avoid damaging your genital area through friction (use a water-based lubricant if you're using latex condoms, as oil-based lubricant can make latex condoms less effective)
If you're a woman and you use a diaphragm for contraception, you may wish to change to another method of contraception
After having sex, empty your bladder as soon as possible to get rid of unwanted bacteria
There is currently no evidence that oestrogen products, used to treat women after the menopause, can prevent cystitis.
People who have catheters need special advice about how to change them without damaging the area. Ask the healthcare professional who is treating you to show you how to do this.

Introduction
Non-alcoholic fatty liver disease (NAFLD) is the term for a wide range of conditions caused by a build-up of fat within the liver cells. It is usually seen in people who are overweight or obese.
A healthy liver should contain little or no fat. Most people with NAFLD only carry small amounts of fat, which doesn't usually cause any symptoms and isn't harmful to the liver. This early form of the disease is known as simple fatty liver, or steatosis.
Simple fatty liver is very common, reflecting the number of people who are obese or overweight.
However, just because simple fatty liver is harmless, it doesn't mean it is not a serious condition:
In some people, if the fat builds up and gets worse, it can eventually lead to scarring of the liver
As the disease is linked to being overweight or obese, people with any stage of the disease are more at risk of developing a stroke or heart attack
NAFLD is often diagnosed after liver function tests (a type of blood test) produce an abnormal result and other liver conditions, such as hepatitis, are ruled out.
This page explains:
The four stages of NAFLD and the symptoms at each stage
Who is affected, and the causes of NAFLD
Living with NAFLD
Four stages of NAFLD
NAFLD is very similar to alcoholic liver disease, but it is caused by factors other than drinking too much alcohol. The four stages are described below.
Stage 1: simple fatty liver (steatosis)
Hepatic steatosis is stage 1 of the condition. This is where excess fat builds up in the liver cells but is considered harmless. There are usually no symptoms and you may not even realise you have it until you receive an abnormal blood test result.
Stage 2: non-alcoholic steatohepatitis (NASH)
Only a few people with simple fatty liver go on to develop stage 2 of the condition, called non-alcoholic steatohepatitis (NASH).
NASH is a more aggressive form of the condition, where the liver has become inflamed. Inflammation is the body's healing response to damage or injury and, in this case, is a sign that liver cells have become damaged.
A person with NASH may have a dull or aching pain felt in the top right of their abdomen (over the lower right side of their ribs).
Stage 3: fibrosis
Some people with NASH go on to develop fibrosis, which is where persistent inflammation in the liver results in the generation of fibrous scar tissue around the liver cells and blood vessels. This fibrous tissue replaces some of the healthy liver tissue, but there is still enough healthy tissue for the liver to continue to function normally.
Stage 4: cirrhosis
At this most severe stage, bands of scar tissue and clumps of liver cells develop. The liver shrinks and becomes lumpy. This is known as cirrhosis.
Cirrhosis tends to occur after the age of 50-60, after many years of liver inflammation associated with the early stages of the disease.
People with cirrhosis of the liver caused by NAFLD often also have type 2 diabetes.
The damage caused by cirrhosis is permanent and can't be reversed. Cirrhosis progresses slowly, over many years, gradually causing your liver to stop functioning. This is called liver failure. Learn more about cirrhosis of the liver, including the warning signs.
Who is affected?
You are more likely to develop NAFLD if you:
Are obese or overweight
Have type 2 diabetes (this causes an increased uptake of fat into the liver cells)
Are over the age of 50
Have high blood pressure
Have high cholesterol
Have experienced rapid weight loss, for example after weight loss surgery or after being malnourished
Living with NAFLD
Most people with NAFLD do not develop serious liver problems and just have stage 1 of the disease (simple fatty liver).
Simple fatty liver may go away if the underlying cause is tackled. For example, losing excess weight or controlling diabetes better can make fatty liver go away.
Many people do not have symptoms, although it's common to feel tired and some people have a persistent pain in the upper right part of their abdomen (where their liver is).
It is important to make lifestyle changes to prevent the disease progressing to a more serious stage and to lower your risk of having a heart attack or stroke.
Losing weight and exercising
The most important thing that people with NAFLD can do is to go on a gradual weight loss programme and exercise regularly. This helps in two ways: by reducing the amount of fat in your liver cells and by lowering your risk of stroke and heart attack. Start losing weight.
Losing weight is particularly important if you have type 2 diabetes.
Stopping smoking
If you smoke, it's really important to give up, as this will also help to reduce your risk of heart attack and stroke.Take steps now to stop smoking.
Medication
If you have high blood pressure or high cholesterol, you may need medical treatment for these.
If you have type 2 diabetes, you may need medicines that reduce high levels of blood sugar. At first, this will usually be in the form of tablets, sometimes a combination of more than one type of tablet. It may also include injections of insulin. Learn more about the medical treatment of type 2 diabetes.
Alcohol
NAFLD is not caused by alcohol, but drinking alcohol may make the condition worse. It's therefore advisable to stop drinking alcohol.

Introduction
Gastro-oesophageal reflux disease (GORD) is a common condition where stomach acid leaks out of the stomach and into the oesophagus (gullet). The oesophagus is a long tube of muscle than runs from the mouth to the stomach.
Common symptoms of GORD include:
Heartburn – burning chest pain or discomfort that occurs after eating
An unpleasant sour taste in the mouth – caused by stomach acid coming back up into the mouth (known as regurgitation)
Dysphagia – pain and difficulty swallowing
Many people experience occasional episodes of GORD, but if people have persistent and reoccurring symptoms it is normally regarded as a condition that needs treatment.
Treatment
A step-by-step approach is usually recommended for GORD. This means that relatively uncomplicated treatments, such as changing your diet, will be tried first.
If this fails to help control symptoms then a person can be 'stepped up' to more complex treatments such as antacids, which help neutralise the effects of stomach acid.
In cases where medication fails to control symptoms, surgery may be required.
Causes
It is thought that GORD is caused by a combination of factors. The most important factor is the lower oesophageal sphincter (LOS) muscle not working properly.
The LOS acts like a valve, opening to let food fall into the stomach and closing to prevent acid leaking out of the stomach and into the oesophagus. In cases of GORD, the LOS does not close properly, allowing acid to leak up, out of the stomach.
Known risk factors for GORD include:
Being overweight or obese
Being pregnant
Eating a high-fat diet
Complications
A common complication of GORD is that the stomach acid can irritate and inflame the lining of the oesophagus, which is known as oesophagitis.
In severe cases of oesophagitis, ulcers (open sores) can form which can cause pain and make swallowing difficult.
A rarer and more serious complication of GORD is cancer developing inside the oesophagus (oesophageal cancer).
Who is affected
GORD is a common digestive condition. It is estimated that one in five people will experience at least one episode of GORD a week, and that 1 in 10 people experience symptoms of GORD on a daily basis.
GORD can affect people of all ages, including children. However, most cases affect adults aged 40 or over. GORD is thought to affect both sexes equally, but males are more likely to develop complications.
Outlook
The outlook for GORD is generally good, and most people respond well to treatment with medication.
However, relapses are common, with around half of people experiencing a return of symptoms after a year. As a result, some people may require a long-term course of medication to control their symptoms.
Symptoms of gastro-oesophageal reflux disease
The three most common symptoms of gastro-oesophageal reflux disease (GORD) are:
Heartburn
Regurgitation of acid into your throat and mouth
Dysphagia (difficulty swallowing
These symptoms are discussed in more detail below.
Heartburn
Heartburn is a burning pain or a feeling of discomfort that develops just below your breastbone. The pain is usually worse after eating, or when bending over or lying down.
Regurgitation
Regurgitation of acid usually causes an unpleasant, sour taste at the top of your throat or the back of your mouth.
Dysphagia
Around one in three people with GORD has problems swallowing (dysphagia). It can occur if the stomach acid causes scarring of the oesophagus, which leads to the oesophagus narrowing, making it difficult to swallow food.
People with GORD-associated dysphagia say it feels like a piece of food has become stuck somewhere near their breastbone.
Less common symptoms of GORD
GORD can sometimes have a number of less common symptoms associated with the irritation and damage caused by stomach acid.
Less common symptoms of GORD include:
Feeling sick
Persistent cough, often worse at the night
Chest pain
Wheezing
Tooth decay
Laryngitis (inflammation of the larynx), which causes throat pain and hoarseness
If you have asthma and GORD, your asthma symptoms may get worse as a result of stomach acid irritating your airways.
When to seek medical advice
If you are only experiencing symptoms such as heartburn once or twice a month, then you probably do not need to seek treatment from Dr. B C Shah.
You should be able to control symptoms by making a number of lifestyle changes and using over-the-counter medication as and when symptoms occur.
You should see Dr. B C Shah if you are having frequent or severe symptoms and finding yourself using over-the-counter medication on a weekly or daily basis. You may require prescription medication to control symptoms and prevent complications.
Causes of gastro-oesophageal reflux disease
It is thought that most cases of gastro-oesophageal reflux disease (GORD) are caused by a problem with the lower oesophageal sphincter (LOS) muscle. The LOS is located at the bottom of the oesophagus (gullet), the tube that runs from the back of the throat to the stomach.
The LOS works in a similar way to a valve. It opens to let food into your stomach, and it closes to prevent acid leaking back up into your oesophagus.
However, in people with GORD, the LOS can become weakened, which allows stomach acid to pass back into the oesophagus. This causes symptoms of heartburn, such as a burning pain or a feeling of discomfort in your stomach and chest.
Exactly what causes the LOS to become weakened is not always clear, but a number of risk factors have been identified.
These are outlined below.
Risk factors
Being overweight or obese – this can place an increased pressure on your stomach, which in turn can weaken the LOS
Having a diet high in fatty foods – the stomach takes longer to dispose of stomach acids after digesting a fatty meal
Consuming tobacco, alcohol, coffee, or chocolate – it has been suggested that these four substances may relax the LOS
Being pregnant – changes in hormone levels during pregnancy can weaken the LOS and increase pressure on your stomach
Having a hiatus hernia – a hiatus hernia is where part of your stomach pushes up through your diaphragm (the sheet of muscle used for breathing)
Stress
There is also a condition called gastroparesis, where the stomach takes longer to dispose of stomach acid. The excess acid can push up through the LOS.
Gastroparesis is common in people who have diabetes, because high blood sugar levels can damage the nerves that control the stomach.
Medication
There are a number of medications that can relax the LOS, leading to the symptoms of GORD.
These include:
Calcium-channel blockers – a type of medication used to treat high blood pressure
Non-steroidal anti-inflammatory drugs (NSAIDs) – a type of painkiller, such as ibuprofen
Selective serotonin reuptake inhibitors (SSRIs) – a type of antidepressant
Corticosteroids (steroid medication) – which are often used to treat severe symptoms of inflammation
Bisphosphonates – used to treat osteoporosis(weakening of the bones)
Nitrates – a medication used to treat angina (a condition that causes chest pain)
Diagnosing gastro-oesophageal reflux disease
In most cases, Dr. B C Shah will be able to diagnose gastro-oesophageal reflux disease (GORD) by asking questions about your symptoms.
Further testing for GORD is usually only required if:
You have dysphagia (difficulty swallowing)
Your symptoms do not improve despite taking medication
Further testing aims to confirm or disprove the diagnosis of GORD while checking for any other possible causes of your symptoms, such as irritiable bowel syndrome.
Endoscopy
An endoscopy is a procedure where the inside of your body is directly examined using an endoscope.
An endoscope is a long, thin flexible tube that has a light source and video camera at one end so that images of the inside of your body can be sent to an external monitor.
To confirm a diagnosis of GORD, the endoscope will be inserted into your mouth and down your throat. The procedure is usually done while you are awake, and you may be given a sedative to help you to relax.
An endoscopy is used to check whether the surface of your oesophagus has been damaged by stomach acid. It can also rule out more serious conditions that can also cause heartburn, such as stomach cancer.
Manometry
If an endoscopy does not find any evidence of damage to your oesophagus, you may be referred for a further test called manometry.
Manometry is used to assess how well your lower oesophageal sphincter (LOS) is working by measuring pressure levels inside the sphincter muscle.
During manometry, one of your nostrils will be numbed using a topical anaesthetic. A small tube will then be passed down your nostril and into your oesophagus to the site of the LOS. The tube contains a number of pressure sensors, which can detect the pressure generated by the muscle, then send the reading to a computer.
During the test, you will be asked to swallow some food and liquid to check how effectively your LOS is functioning.
A manometry test takes around 20 to 30 minutes to complete. It is not painful, but you may have minor side effects including:
A nosebleed
A sore throat
However, these side effects should pass quickly once the test has been completed.
Manometry can be useful for confirming a diagnosis of GORD, or for detecting less common conditions that can disrupt the normal workings of the LOS, such as muscle spasms or achalasia (a rare swallowing disorder).
Barium swallow
If you are experiencing symptoms of dysphagia then you may be referred for a test known as a barium swallow.
The barium swallow test is one of the most effective ways of assessing your swallowing ability and finding exactly where the problems are occurring. The test can often identify blockages or problems with the muscles used during swallowing.
As part of the test, you will be asked to drink some barium solution. Barium is a non-toxic chemical that is widely used in tests because it shows up clearly on an X-ray. Once the barium moves down into your upper digestive system, a series of X-rays will be taken to identify any problems.
If you need to have a barium meal X-ray, you will not be able to eat or drink anything for at least six hours before the procedure so that your stomach and duodenum (top of the small intestine) are empty. You may be given an injection to relax the muscles in your digestive system.
You will then lie down on a couch and your specialist will give you a white, chalky liquid to drink which contains barium. As the barium fills your stomach, your specialist will be able to see your stomach on an X-ray monitor, as well as any ulcers or abnormal growths. Your couch may be tipped slightly during the test so that the barium fills all the areas of your stomach.
A barium swallow usually takes about 15 minutes to perform. Afterwards you will be able to eat and drink as normal, although you may need to drink more water to help flush the barium out of your system. You may feel slightly sick after a barium meal X-ray, and the barium may cause constipation. Your stools may also be white for a few days afterwards as the barium passes through your system.
24-hour pH monitoring
If the manometry test cannot find problems with your oesophageal sphincter muscles, another test known as 24-hour pH monitoring can be used (pH is a unit of measurement used in chemistry, and describes how acidic a solution is). The lower the pH level, the more acidic the solution is.
The 24-hour pH monitoring test is designed to measure pH levels around your oesophagus. You should stop taking medication used to treat GORD for seven days before having a 24-hour pH test because the medication could distort the test results.
During the test, a small tube containing a probe will be passed through your nose to the back of your oesophagus. This is not painful but can feel a little uncomfortable.
The probe is connected to a portable recording device about the size of an MP3 player, which you wear around your wrist. Throughout the 24-hour test period, you will be asked to press a button on the recorder every time you become aware of your symptoms.
You will be asked to complete a diary sheet by recording when you have symptoms upon eating. Eat as you normally would to ensure an accurate assessment can be made.
After the 24-hour period is over, the probe will be removed so measurements on the recorder can be analysed. If test results indicate a sudden rise in your pH levels after eating, a confident diagnosis of GORD can usually be made.
Treating gastro-oesophageal reflux disease
A number of self-care techniques may help relieve symptoms of gastro-oesophageal reflux disease (GORD). They are described below.
If you are overweight, losing weight may help reduce the severity and frequency of your symptoms because it will reduce pressure on your stomach.
If you are a smoker, consider quitting. Tobacco smoke can irritate your digestive system and may make symptoms of GORD worse.
Eat smaller, more frequent meals, rather than three large meals a day. Make sure you have your evening meal three to four hours before you go to bed.
Be aware of triggers that make your GORD worse. For example, alcohol, coffee, chocolate, tomatoes, or fatty or spicy food. After you identify any food that triggers your symptoms, remove them from your diet to see whether your symptoms improve.
Raise the head of your bed by around 20cm (8 inches) by placing a piece of wood, or blocks under it. This may help reduce your symptoms of GORD. However, make sure your bed is sturdy and safe before adding the wood or blocks. Do not use extra pillows because this may increase pressure on your abdomen.
If you are currently taking medication for other health conditions, check with DR. B C Shah to find whether he may be contributing to your symptoms of GORD. Alternative medicines may be available. Do not stop taking a prescribed medication without consulting Dr. B C Shah first.
Medication
A number of different medications can be used to treat GORD. These include:
Over-the-counter medications
Proton-pump inhibitors (PPIs)
H2-receptor antagonists
Prokinetics
Depending on how your symptoms respond, you may only need medication for a short while or alternatively on a long-term basis.
These are described below.
Over-the-counter medications
A number of over-the-counter medicines can help relieve mild to moderate symptoms of GORD.
Antacids are medicines that neutralise the effects of stomach acid. However, antacids should not be taken at the same time as other medicines because they can stop other medicines from being properly absorbed into your body. They may also damage the special coating on some types of tablets. Ask Dr. B C Shah for advice.
Alginates are an alternative type of medicine to antacids. They work by producing a protective coating that shields the lining of your stomach and oesophagus from the effects of stomach acid.
Proton-pump inhibitors (PPIs)
If GORD fails to respond to the self-care techniques described above, Dr. B C Shah may prescribe a one month course of proton-pump inhibitors (PPIs) for you. PPIs work by reducing the amount of acid produced by your stomach.
Most people tolerate PPI well and side effects are uncommon.
When they do occur they are usually mild and may include
Headaches
diarrhoea
feeling sick
abdominal pain
constipation
dizziness
skin rashes
In order to minimise any side effects, Dr. B C Shah will prescribe the lowest possible dose of PPIs that they think will be effective in controlling your symptoms. Therefore, inform Dr. B C Shah if he can prescribe PPIs for you that prove ineffective. A stronger dose may be needed.
Sometimes, the symptoms of GORD can return after a course of PPIs has been completed. Go back to see Dr. B C Shah if you have further or persistent symptoms.
In some cases you may need to take PPIs on a long-term basis.
H2-receptor antagonists
If PPIs cannot control your symptoms of GORD, another medicine known as an H2-receptor antagonist (H2RA) may be recommended to take in combination with PPIs on a short-term basis (two weeks), or as an alternative to them.
H2RAs block the effects of the chemical histamine, used by your body to produce stomach acid. H2RAs therefore help reduce the amount of acid in your stomach.
Side effects of H2RAs are uncommon. However, possible side effects may include:
Diarrhoea
Headaches
Dizziness
Tiredness
A rash
Some types of H2RAs are available as over-the-counter medicines. These types of HR2As are taken in a lower dosage than the ones available on prescription. Ask Dr. B C Shah if you are not sure whether these medicines are suitable for you.
Prokinetics
If your GORD symptoms are not responding to other forms of treatment, Dr. B C Shah may prescribe a short-term dose of a prokinetic.
Prokinetics speed up the emptying of your stomach, which means there is less opportunity for acid to irritate your oesophagus.
A small number of people who take prokinetics have what is known as ‘extrapyramidal symptoms’. Extrapyramidal symptoms are a series of related side effects that affect your nervous system. Extrapyramidal symptoms include:
Muscle spasms
Problems opening your mouth fully
A tendency to stick your tongue out of your mouth
Slurred speech
Abnormal changes in body posture
If you have the above symptoms while taking prokinetics, stop taking them and contact Dr. B C Shah or out-of-hours doctor immediately. He may recommend your dose is discontinued.
Extrapyramidal symptoms should stop within 24 hours of the medicine being withdrawn.
Prokinetics are not usually recommended for people under 20 years old because of an increased risk of extrapyramidal symptoms.
Surgery
Surgery is usually only recommended in cases of GORD that fail to respond to the treatments listed above.
Alternatively, you may wish to consider surgery if you have persistent and troublesome symptoms but do not want to take medication on a long-term basis.
While surgery for GORD can help relieve your symptoms, there are some associated complications that may result in you developing additional symptoms, such as:
Dysphagia (difficulty swallowing)
Flatulence
Bloating
An inability to belch (burp)
Discuss the advantages and disadvantages of surgery with Dr. B C Shah before making a decision about treatment.
Surgical procedures that are used to treat GORD include:
Laparoscopic nissen fundoplication (LNF)
Endoscopic injection of bulking agents
Endoluminal gastroplication
Endoscopic augmentation with hydrogel implants
Endoscopic radiofrequency ablation
These procedures are discussed below.
Laparoscopic nissen fundoplication (LNF)
Laparoscopic nissen fundoplication (LNF) is one of the most common surgical techniques used to treat GORD.
LNF is a type of keyhole surgery that involves the surgeon making a series of small incisions (cuts) in your abdomen (tummy). Carbon dioxide gas is then used to inflate your abdomen to give the surgeon room to work in.
During LNF, the surgeon will wrap the upper section of your stomach around your oesophagus and staple it in place. This will contract (tighten) your lower oesophageal sphincter (LOS), which should prevent any acid moving back out of your stomach.
LNF is carried out under general anaesthetic, which means you will not feel any pain or discomfort. The surgery takes 60 to 90 minutes to complete.
After having LNF, most people can leave hospital once they have recovered from the effects of the general anaesthetic. This is usually within two to three days. Depending on the type of job you do, you should be able to return to work within three to six weeks.
For the first six weeks after surgery, it is recommended you only eat soft food, such as mince, mashed potatoes or soup. Avoid eating hard food that could get stuck at the site of the surgery, such as toast, chicken or steak.
Common side effects of LNF include:
Dysphagia (difficulty swallowing)
Belching
Bloating
Flatulence
These side effects should resolve over the course of a few months. However, in about 1 in 100 cases they can be persistent. In such circumstances, further corrective surgery may be required.
New surgical techniques
In the last decade, a number of new surgical techniques have been introduced for the treatment of GORD.
All techniques discussed below are non-invasive, which means no incisions need be made into your body. Therefore, they can usually be performed under local anaesthetic on a day surgery basis, so you should not have to spend the night in hospital.
Endoscopic injection of bulking agents
Endoscopic injection of bulking agents involves the surgeon using an endoscope to find the site where stomach and oesophagus meet (known as the gastro-oesophageal junction).
A thin tube called a catheter is then passed down the endoscope, and used to inject a combination of plastic and liquid into the junction. This narrows the junction and helps to prevent acid leaking up from the stomach.
The most common side effect of this type of surgery is mild to moderate chest pain. This develops in around a half of all cases.
Other side effects include:
Dysphagia
Feeling sick
High temperature of 38ºC (100.4ºF) or above
These side effects should resolve within a few weeks.
Endoluminal gastroplication
Endoluminal gastroplication involves the surgeon using an endoscope to sow a series of pleats (folds) into the LOS. The pleats should restrict how far the LOS can open, preventing acid leaking up from your stomach.
Side effects of this type of surgery include:
Chest pain
Abdominal (tummy) pain
Vomiting
Sore throat
These side effects should improve within a few days.
Endoscopic augmentation with hydrogel implants
Endoscopic augmentation with hydrogel implants is a similar technique to an endoscopic injection, except the surgeon uses hydrogel to narrow your gastro-oesophageal junction. Hydrogel is a type of flexible plastic gel very similar to living tissue.
The most common complication arising from this procedure is that the hydrogel starts to come out of the gastro-oesophageal junction. One study found this happened in one in five cases. However, this is a relatively new technique and success rates may well improve in future.
Endoscopic radiofrequency ablation
In endoscopic radiofrequency ablation, the surgeon passes a balloon down an endoscope to the site of your gastro-oesophageal junction. The balloon is then inflated.
Tiny electrodes are attached to the outside of the balloon and small pulses of heat generated. This creates small scars in the tissue of your oesophagus, causing it to narrow and making it more difficult for stomach acid to leak out of your stomach.
Out of all the new surgical techniques mentioned, there is little known about the safety of endoscopic radiofrequency ablation. Possible complications and side effects may include:
Chest pain
Dysphagia
Injury to the oesophagus
LINK Reflux Management System
A new type of surgery introduced in 2011, is the LINK Reflux Management System.
This type of keyhole surgery uses magnetic beads to reinforce the LOS muscle.
The magnetic force of the beads helps keep the LOS closed when at rest, preventing stomach acid leaking upwards. The LOS opens normally when swallowing.
This type of surgery appears effective and safe in the short-term but as it is a new technique, its long-term effectiveness and safety are unclear.
Complications of gastro-oesophageal reflux disease
Oesophageal ulcers
The excess acid produced by gastro-oesophageal reflux disease (GORD) can damage the lining of your oesophagus (oesophagitis) which can lead to the formation of ulcers. The ulcers can bleed, causing pain and making swallowing difficult. Ulcers can usually be successfully treated by controlling the underlying symptoms of GORD.
Medications used to treat GORD can take several weeks to become effective, so it is likely Dr. B C Shahwill recommend additional medication to provide short-term relief from your symptoms.
Two types of medication that can be used are:
antacids to neutralise stomach acid on a short-term basis
alginates, which produce a protective coating on the lining of your oesophagus
Both antacids and alginates are over-the-counter medications available from pharmacists. The pharmacist will advise you on the types of antacid and alginate most suitable for you.
Antacids are best taken when you have symptoms, or when symptoms are expected, such as after meals or at bedtime. Alginates are best taken after meals.
Side effects for both medications are uncommon but include:
diarrhoea
vomiting
flatulence
Oesophageal stricture
Repeated damage to the lining of your oesophagus can lead to the formation of scar tissue. If the scar tissue is allowed to build up, it can cause your oesophagus to become narrowed. This is known as oesophageal stricture.
An oesophageal stricture can make swallowing food difficult and painful. Oesophageal strictures can be treated by using a tiny balloon to dilate (widen) the oesophagus. This procedure is usually carried out under a local anaesthetic.
Barrett’s oesophagus
Repeated episodes of GORD can lead to changes in the cells lining of your lower oesophagus. This is a condition known as Barrett’s oesophagus.
It is estimated that 1 in 10 people with GORD will develop Barrett’s oesophagus. Most cases of Barrett’s oesophagus first develop in people aged 50-70 years old. The average age at diagnosis is 62.
Barrett’s oesophagus does not usually cause noticeable symptoms other than those associated with GORD.
The concern is that Barrett’s oesophagus is a pre-cancerous condition. This means that while changes in the cells are not cancerous, there is a small risk they could develop into ‘full blown’ cancer in the future. This would then trigger the onset of oesophageal cancer (see below).
Oesophageal cancer
Risk factors that increase the risk of cells in the lining of your oesophagus turning cancerous include:
Being male
Having the symptoms of GORD for longer than 10 years
Having three or more episodes of heartburn and related symptoms a week
Smoking
Obesity
If it is thought that you have an increased risk of developing oesophageal cancer, it is likely you will be referred for regular endoscopies to monitor the condition of the affected cells.
If oesophageal cancer is diagnosed in its initial stages, it is usually possible to cure the cancer using a treatment called photodynamic therapy (PDT).
PDT involves injecting your oesophagus with a medication that makes it sensitive to the effects of light. A laser attached to an endoscope is then placed inside your oesophagus and burns away the cancerous cells.