Further Treatment

Lymph Node Dissection – Axillary, groin, neck dissection

A dissection is performed under general anaesthetic (i.e. you will be “asleep”) and involves the removal of all of the lymph nodes in an area. An axillary dissection, for example, is the removal of all the lymph nodes in an armpit.

Radiation Therapy

Radiotherapy (also known as x-ray treatment or irradiation) uses x-rays to destroy cancer cells. Although radiotherapy can damage normal cells, they usually repair themselves and special care is taken to ensure that there is as little harm as possible to health tissue cells. Radiotherapy is usually given over several weeks and the length of the treatment will depend on the size and location of the melanoma as well as your general health.

Before you begin radiation treatment you will need to have simulation or “planning”. Simulation involves you lying very still on a table while a radiation therapist defines your treatment field so that the radiation can be focussed specifically on that area. CT scans or other imaging studies may be used in order to accurately plan where to deliver the radiation. You may also find that moulds or other devices are used to stop you from moving. The radiation therapist will also mark the area on your skin where treatment is to be directed. If so, these will be used each time you have your treatment. Simulation usually takes between half an hour and an hour.

When you begin your radiation therapy treatments you may be asked to change into a hospital gown at the start of each treatment. In the treatment room, the radiation therapists will use the markings on your skin to ensure that the radiation is delivered to the correct area. Radiation treatment is painless and not at all uncomfortable. You will not be aware of the radiation in any way. For each radiation treatment you will be in the treatment room for 10 to 20 minutes, however the radiation itself will only be delivered for about 2 to 5 minutes of that time.

You may have other areas of your body covered with special shields to protect normal tissues and organs. You will need to keep very still during the radiation treatments to ensure that the radiation is delivered to the area where it is needed. The radiation therapist will not be in the room with you while you are having you treatment. They will be in another room controlling the equipment. The radiation therapist can see and hear you and so if you do feel ill or very uncomfortable during the treatment you will be able to tell them and they will stop the treatment.

Your doctor will follow your progress while you are having the radiation therapy and may alter the radiation dose or the number and length of your sessions accordingly. It is important to note that you are not radioactive even immediately after these treatments and therefore you can continue your relationships with others as per usual. You do not need to worry about getting close to other people.

The side effects of radiation treatment can include temporary or permanent hair loss, skin irritation, temporary changes in skin colour (in the treated area) and tiredness. There may be some other side effects depending on the treatment site; your Radiation Oncologist will be able to discuss these with you.

Chemotherapy

Chemotherapy uses anti-cancer or cytotoxic drugs to destroy cancer cells. Chemotherapy stops cancer cells from dividing and multiplying. It travels through the blood stream which means that it is able to reach cancer cells in different parts of the body. Chemotherapy affects cells which grow very quickly, like cancer cells; this means however that it can affect other fast growing cells in the body. This is why some people lose their hair or have a sore mouth or mouth ulcers for example. Most cells in the body are not fast growing and so will not be affected by the chemotherapy. Even when “normal” cells, like hair cells, are damaged they can grow back again whereas cancer cells are less likely to grow back when damaged by chemotherapy.

Chemotherapy can be used for melanoma that has returned to the site where it first started, melanoma that has spread to another part of the body or to try and stop melanoma from returning if cancer cells were found in your lymph nodes. It is important to know that when it comes to melanoma, chemotherapy is still experimental and has not yet been proven to help prevent melanoma from returning or that it can help treat advanced melanoma.

There are different types of chemotherapy drugs. These can be given individually or in combination. You will have your chemotherapy drugs (in injectable, intravenous or oral tablet form) for a few days. Then you will have 3 – 4 weeks without any treatment. Then you will start again with another few days of the chemotherapy. This cycle is usually repeated 6 or more times to make up a “course” of chemotherapy.

The side effects of chemotherapy depend on which of the chemotherapy drugs you are given, how much of each drug you are given and how sensitive you are as an individual to each drug. The most common side effects include nausea, diarrhoea, sore mouth and mouth ulcers, feeling run down or tired, a drop in your blood cells. Ask your Doctor for a list of the common side effects for the chemotherapy drugs you are taking. Remember to tell your Doctor as soon as you have symptoms so that s/he can help you manage these as much as possible. You will probably feel very tired by the end of your chemotherapy course, but the side effects will go away once the treatment has finished. It can take a while for you to get you energy back so remember to ask friends and/or family for help if you need it.