Radiation Side Effects

High doses of radiation are used to target and destroy cancer cells. To help ensure that all the cancer is destroyed, doctors deliver radiation with a margin (an area of healthy cells), surrounding the cancer area. This is to ensure that no abnormal cells are missed.

During and after treatment, the radiation damages both cancerous and healthy cells. The cancerous cells are not able to repair themselves and heal, while the healthy cells can typically heal. This is the reason for treating in several fractions (small doses over several days), which gives healthy cells a chance to recover. The cells recovering is what often causes fatigue — the most common side effect of radiation therapy.

Each organ in the body or type of tissue can withstand certain amounts of doses of radiation. When radiation is delivered to different areas of the body, different side effects will occur. Some side effects are short-term, while others are longer-term. Some side effects are enhanced or made worse by concurrent chemotherapy treatments.

Side effects are most common within, or due to changes within, the treatment area (including the margin) that received radiation.
Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. They’re usually gone within a few weeks after treatment ends. The most common early side effects are fatigue (feeling tired) and skin changes. Other early side effects are usually related to the area being treated, such as hair loss and mouth problems (that can include inflammation of the gums, taste changes, dry mouth, and pain).

Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated, as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. It’s always best to talk to your radiation oncologist about the risk of long-term side effects.

Many side effects are dependent on the location of treatment being delivered:

Breast:
Skin changes, reddening, swelling, tenderness.

Head and Neck:
Side effects – dry mouth, mouth and gum sores, difficulty swallowing, nausea, hair loss (in treated area), swelling (lymphedema), tooth decay.

Chest:
Difficulty swallowing, shortness of breath, stiffness in shoulders (depending on site), fullness of chest (radiation pneumonitis – occurs post therapy), hair loss (in treated area).

Stomach:
Nausea and vomiting, diarrhea – the MD can prescribe medications that will help with these types of side effects for patients.

Pelvis:
Diarrhea, rectal bleeding, incontinence (when you cannot control your bladder), hair loss (in treated area). For men: ED, lowered sperm counts, fertility problems. For women: changes in menstrual cycle, symptoms of menopause (itching, burning, dryness), fertility problems.

Brain:
Hair loss, fatigue, nausea and vomiting, headache, vision blurriness.

Head & Neck:
Fatigue, hair loss, difficulty swallowing, mouth changes, less active thyroid, taste changes.

Most common side effects:
Fatigue: see above
During radiotherapy, you might require a little more rest than you are used to. You might need a nap (if possible) or to go to bed earlier at night to give your body more recovery time. This is very dependent on treatment site and treatment dose. Be patient with yourself – just because you can’t see the radiation doesn’t mean it is not having an effect on your energy levels.

Skin Problems / Erythema / Redness of skin:
Some people, depending on treatment location and dose, experience dryness, itching, reddening, blistering, or peeling of the skin. Doctors can prescribe topical medicines to alleviate pain associated with this or to help heal the skin. Sometimes special bandages are used as well.
You may need to be gentle with your skin. Here are some ways to do this:

  • Do not wear tight, rough-textured, or stiff clothes over the treatment area. This includes anything tight or elastic that squeezes the area. Instead, wear loose clothing made from soft, smooth fabrics. Starch in your clothes is not recommended.
  • Do not put heat or cold (such as a heating pad, heat lamp, or ice pack) on the treatment area without talking to your cancer care team first. Even hot water may hurt your skin, so use only lukewarm water for washing the treated area.
  • Protect the treated area from the sun. Your skin may be extra sensitive to sunlight. If possible, cover the treated skin with dark-colored or UV-protective clothing before going outside. Ask your cancer care team if you should use sunscreen. If so, use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30. Reapply the sunscreen often. Continue to give your skin extra protection from sunlight, even after radiation therapy ends.
  • Use only lukewarm water and mild soap. Just let water run over the treated area. Do not rub. Also, if you have them, be careful not to rub away the ink marks needed for your radiation therapy until it’s done.
  • Check with your cancer care team before shaving the treated area. They might recommend that you use an electric shaver.
  • Ask your cancer care team before using anything on the skin in the treatment area. This includes powders, creams, perfumes, deodorants, body oils, ointments, lotions, hair-removal products, or home remedies while you’re being treated and for several weeks afterward. Many skin products can leave a coating on the skin that can cause irritation, and some may even affect the dose of radiation that enters the body.

Your cancer care team can tell you about your treatment, likely side effects, and things you need to do to take care of yourself. They can also talk to you about any other medical concerns you have. Tell them about any changes you feel and any side effects you have, including skin changes, tiredness, diarrhea, or trouble eating. Be sure that you understand any home care instructions and know who to call, if you have more questions. Also be sure you know what to do if you need help after office hours, in case you have problems at night or on the weekend.

What questions should you ask your doctors?