General side effects of external radiotherapy

 

Tiredness Back to top

You may feel very tired| during your radiotherapy. This can often be made worse by having to travel to hospital each day. Listen to your body, and if necessary allow yourself extra time to rest, perhaps by taking a nap. It may help if you spread chores out over the week, sit down to do them wherever possible, and accept any offers of help. Tiredness can be a problem for some months after your treatment has finished.

Eating and drinking Back to top

As always during treatment of any kind, it’s important to maintain a healthy diet| and drink plenty of fluids. At times you probably won't feel like eating, or you may find that your eating habits change. It may be easier to have small snacks throughout the day rather than large meals. It’s not unusual to lose a little weight during radiotherapy, but if you're having any problems with eating it is important to tell the radiotherapy staff. They can arrange for you to talk to the dietitian at the hospital.

Skin care Back to top

Some people develop a skin reaction while having external radiotherapy. If this affects you, it will normally happen after 3–4 weeks. People with pale skin may find that the skin in the treatment area becomes red and sore or itchy. People with darker skin may find that their skin becomes darker and can have a blue or black tinge. The amount of the reaction depends on the area being treated and the individual's skin. Some people have no skin problems at all. Your radiographers will be looking for these reactions, but you should also let them know as soon as you notice any soreness or change in skin colour.

It’s important not to use any creams or dressings unless they have been prescribed or recommended by your specialist or the radiographer.

Occasionally, if your skin gets very sore, your treatment may have to be delayed for a short time to allow the area to recover.

Staff at the radiotherapy department will be able to give you advice on how to look after your skin in the area being treated. This will vary according to the part of the body that is being treated and the dose of radiotherapy.

You may be advised to use only tepid water and unperfumed soaps to wash the area, and not to soak too long in the bath. You can dry your skin by patting it gently with a soft towel, but you shouldn’t rub the area as this may make it sore.

Perfumed soaps, talcum powder, deodorants and perfumes may also make your skin sore and should not be used. The staff at the hospital may suggest that you gently apply plain moisturisers, such as E45 cream or aqueous cream, to the area. After your treatment, plain soap and plain moisturisers are often recommended. Aloe vera cream or arnica cream can sometimes help the skin to heal. Always check with the radiotherapy staff before applying anything to your skin.

It is very important that any marks put on your skin to show the treatment area are not removed. If the marks do fade or disappear, don’t try to replace them yourself but let the radiotherapy staff know.

Men who are having radiotherapy to the head and neck may be advised not to shave the area, or to use an electric razor rather than wet-shaving.

These restrictions apply only to the treatment area, and the rest of your skin can be treated normally. Your skin may peel after the redness has faded, but it will gradually heal. Changes in the skin usually settle down two to four weeks after the treatment has finished, but the area may stay slightly darker than the surrounding skin.

Avoiding the sun Back to top

Your skin in the treated area is very sensitive and needs protecting from the sun or cold winds. If you're having radiotherapy to your head or neck, try wearing a hat or a silk or cotton scarf when you go outside.

For at least the first year after your radiotherapy, it’s very important to cover the treated area if you go out in strong sunshine. Wear clothes made of cotton or natural fibres, which have a closer weave and offer more protection against the sun. Even after this time the area of treated skin will be more delicate than normal, so take extra care. Use a sun-cream (of at least factor 15) and cover the area with a hat or close-weave clothing. It’s important to remember that you can burn even through clothing if you are out in hot sun for a long time.

You can swim as soon as any skin reaction has settled down, usually within a month of finishing treatment. If you are swimming outdoors however, don’t stay in the water too long, and remember to use a waterproof sun-cream.

Clothing Back to top

Loose-fitting clothes, preferably in natural fibres rather than man-made materials, are more comfortable and less irritating to the skin. Avoid tight collars and ties if you’re having radiotherapy to your neck.

Shoulder straps and bra straps can also cause irritation if they rub against treated skin. If your breast area is being treated, you may be more comfortable not wearing a bra or wearing a cropped top or vest.

Hair loss Back to top

With radiotherapy you lose hair within the treatment area, but it can also happen where the radiation beam leaves the body (for example, on the back of the neck), as well as where it enters the body. Ask your clinical oncologist or radiographer to show you exactly where your hair will fall out. The hair usually begins to fall out after two to three weeks. Hair should grow back after treatment is finished, although this depends on the dose of radiotherapy you have. Your radiographer can explain if your hair loss is likely to be permanent.

You may need to find ways of covering up the hair loss and there are several ways of doing this. You can find out more in the section on coping with hair loss|.

Changes in your blood Back to top

Radiotherapy to some parts of the body may affect the bone marrow, which is where the different types of blood cells are made. If the doctors think this might happen to you, you will have regular blood tests during your treatment to check the number of cells in your blood (your blood count). If your blood count is low, you may feel tired and run down. If your blood count becomes very low (which is unlikely), it may be necessary to have a short rest from treatment so that your blood cell levels can return to normal. You may also need to have a blood transfusion|.

It is very important to let your doctors know if you feel very unwell, if your temperature goes above 38ºC (100.4ºF), or if you start feeling cold and shaky.

Smoking Back to top

Stopping smoking during and after radiotherapy is very worthwhile. Research has shown that it may make the radiotherapy more effective as well as reducing the side effects. It will also improve your general health and reduce your risk of developing other cancers.

Stopping smoking or even cutting down at such a stressful time can be very difficult, but do your best. If you want help or advice you can talk to your specialist, GP or a specialist nurse, who will be able to suggest ways of stopping. Organisations such as QUIT| also offer advice and valuable support.

Long-term side effects Back to top

All cancer treatments (including surgery|, chemotherapy| and radiotherapy) can result in long-term side effects. Modern ways of giving radiotherapy are designed to limit the chance of permanent side effects as much as possible and very few people develop long-term effects nowadays. If you are concerned about the risk of developing particular side effects from radiotherapy, it’s best to speak to your specialist before treatment starts.

Possible long-term side effects

Below are some of the long-term side effects that can occur, but they will depend upon the part of the body| that was treated (so you won’t necessarily experience all of them). The long-term side effects can take months and sometimes years to develop.

• Hair loss can sometimes be permanent or new hair growth may be a different colour or texture.
• The skin can feel different or may be darker than before.
• Infertility – if the ovaries or testicles are within the treatment area.
• Swelling in a limb or on the body (lymphoedema) because lymph nodes are damaged.
• Red ‘spidery’ marks (telangectasia) may appear on the skin because small blood vessels are damaged.
• Shortness of breath – radiotherapy can make the lungs less stretchy.
• Narrowing of the vagina.
• Difficulty swallowing due to a narrowing of the gullet (oesophagus) or reduced amounts of saliva.
• Frequency passing urine because the bladder can become less stretchy after radiotherapy.

Second cancers

Radiotherapy can cause cancer and a small number of people will develop a second cancer because of the treatment they have had. However, the chance of a second cancer developing is so small that the risks of having radiotherapy are far out-weighed by the benefits. If you are concerned about your risk of developing a second cancer you should discuss your worries with your specialist.