Managing Side Effects

Managing Side Effects

Radiation that destroys cancer cells can also injure nearby normal healthy cells which could potentially result in unfavorable side effects.

 

If side effects occur it is generally limited to the area of the body that is treated with radiation. It is important for you to talk with your doctor about any symptoms. This section provides information about general personal care for managing common side effects that may be related to radiation therapy. The side effects are listed under the associated treated areas of the body.
 

Common side effects

Fatigue

Fatigue is the most common side effect of radiation therapy.  Fatigue may also be caused by other factors such as anxiety, sleep disturbance, or medication.  Some measures that may help with fatigue include optimizing sleep quality, allowing time for rest periods, and participating in an exercise program.  Always consult with your doctor before beginning an exercise program.
 

Site-specific side effects

Hair Loss

Hair loss may occur in the area of the body where radiation is delivered.  Hair loss is usually not permanent and regrowth occurs within six to nine months.  The new hair may be a different color or texture.  Sometimes, with higher doses of radiation, the hair does not grow back the way it did before treatment.  

Some tips to manage hair loss include:

  • Obtain a wig before you lose your hair so it can be more closely matched to your hair color or texture.

  • Obtain a prescription for a wig from your physician which may be covered by insurance.

  • Consider wearing a synthetic wig. Synthetic wigs are easier to style than human hair wigs.

  • Wigs may be hot or itchy. Consider wearing a soft cotton turban or scarf in place of a wig.

  • Gently comb the hair with a wide-tooth comb. Clean the hair as directed by manufacturer.

  • Wear a hat or scarf in cool weather to help reduce heat loss from your head.

  • Protect the scalp from the sun with a hat or sunscreen.

  • Wear a hair net or turban to sleep to keep hair from coming out in clumps.

  • Avoid stress to the hair such as curling irons, or styles that pull on the hair such as ponytails.

Skin

Radiation delivered from outside the body passes through the skin as it travels to targeted cancer cells. Just as the cancer cells are damaged, healthy skin cells are damaged too.  After a few days to weeks of radiation therapy, the skin over the treatment field may become pink or reddened and start to feel dry and itchy or sting like a sunburn.  Your physician, nurse, and radiation therapists will monitor your skin throughout your treatment.  If you notice a blister or open, moist area over the treatment site, notify a member of your treatment team right away.  

You can help reduce damage to the skin by following these skin care guidelines:

  • Keep water temperature as lukewarm as comfortable when showering or bathing 

  • Use a mild soap; fragrance-free and dye-free is best

  • Allow lukewarm, soapy water to run over the skin of the treatment field when bathing rather than rubbing 

  • Pat your skin dry with a soft towel rather than rubbing the area

  • Keep your fingernails short and clean; avoid scratching or touching skin over the treatment field 

  • Consult with your physician before applying creams or lotions; use only those that your doctor recommends

  • Wear loose, cotton clothing

  • Keep the room where you spend most of your time cool and humid

  • Avoid shaving the area over the treatment field

  • Protect skin from sunlight by covering or applying SPF 30 or greater sunscreen, even on cloudy days

  • Do not use tanning beds

  • Do not use adhesive bandages or tape on the skin over the treatment field

  • Rinse your anal area well with a bottle after bowel movements if the rectum or pelvis is treated

Unlike cancer cells, healthy skin cells can repair themselves and the skin will heal over a few days to weeks after treatment.  Often, the area will fade to a tan and then return to an even tone after a few months.  Your skin will be more sensitive, particularly to sunlight, in the future.  You should always protect your skin by keeping it covered or applying a SPF 30 or greater sunscreen.  Ask your physician or nurse about additional skincare options.  

 

Head, neck, chest or upper spine

Mouth or Throat

A sore mouth or throat should always be evaluated by your doctor determine if there is an infection or other problem requiring medical intervention.  The mouth or throat may become inflamed when radiation is given to the head or neck.  Some dietary measures to help manage sore mouth or throat include consuming foods that are soft, low in acid, neutral or slightly cool in temperature, and low in salt and spices.  Avoiding carbonated beverages is also helpful.  Throat lozenges may be soothing and keep the mouth and throat moist.  If it is still difficult to consume food and beverage with diet modification, ask your doctor about medications to relieve pain.

 

Abdomen, pelvis or lower spine

Diarrhea

Diarrhea can occur when radiation is delivered to the abdomen, pelvis or lower spine area. There may be some inflammation of the bowel which can cause loose stools or an increase in the frequency of the stools. This can often be managed with fluid replacement and changes in diet.

  • Choose low-fiber, low-residue foods (rice, noodles, cream of wheat, well-cooked eggs, bananas, white toast, canned or cooked fruit without skin, skinned turkey or chicken, fish, and mashed potatoes) 

  • Avoid insoluble fiber (raw fruit and vegetables, whole-grain bread, nuts, popcorn, skins, seeds, legumes) 

  • Avoid spicy, greasy, fatty, or fried foods 

  • Avoid milk products 

  • Avoid alcohol 

  • Drinks plenty of fluids, such as water, diluted cranberry juice, broth, and decaffeinated tea or coffee 

  • Avoid or limit caffeine to less than 2–3 servings coffee, tea, or cola 

  • Eat small frequent meals 

  • Drink liquids at room temperature 

  • Increase intake of foods high in sodium and potassium, such as bananas and potatoes

It is important to talk to your doctor about your symptoms and ask about other possible causes of diarrhea such as medication or infection.

Nausea and Vomiting

Nausea and vomiting may be experienced when radiation is delivered to the abdomen.  Sometimes, anxiety about treatment can also cause nausea and vomiting.  This is called anticipatory nausea and vomiting.  Medications are given to help relieve these side effects.  Sometimes, nausea is best managed by preventing it.  Be sure to take your medication as prescribed by your doctor.  

Dietary changes and practices can be very helpful to relieve or reduce nausea and/or vomiting.  These include:

  • Rinse your mouth well before consuming foods and beverages 

  • Use plastic utensils to avoid metallic taste

  • Consume foods that are bland and neutral in temperature

  • Avoid strong odors and gas-producing foods (i.e. broccoli)

  • Eat frequent, small meals

  • Consume clear hydrating liquids (ginger ale, broth, apple juice, weak tea, popsicles, and gelatin)

  • Consume foods that you enjoy, try small amounts of foods that are high in calories and protein 

  • Try distracting yourself by playing soft music in the background or watching television while you eat

  • When you are nauseous, try resting and relaxing, taking slow and deep breaths

If you are vomiting:

  • Lie on your side to avoid vomit entering your airway

  • Use or request nausea medication that does not have to be swallowed

  • When vomiting has stopped, consume ice chips or small, frequent sips of clear liquids

Call your doctor if:

  • You believe vomit has entered the airway

  • Vomiting occurs more than three times in one hour for 3 or more hours

  • Vomit contains blood or material that looks like coffee grounds

  • You are unable to tolerate at least 32 ounces of fluids in a day or eat foods for more than 48 hours

  • You are unable to take your medications

  • You develop headache, weakness, dizziness, or confusion

  • You experience loss of 2 or more pounds in a day

  • Your urine becomes dark yellow, has strong odor, or you haven’t urinated in more than 8 hours

Sexuality and Fertility (Men; pelvis)  

Cancer and cancer treatments can affect sexuality in various ways.  Radiation to the pelvis can damage the nerves that allow an erection to occur.  Radiation to the pelvis can also lead to fibrosis of the blood vessels that carry blood to the penis, making it difficult to obtain or maintain an erection.  Fatigue and imbalance in hormone levels can lead to decreased libido (sex-drive).  Changes in appearance may lead to a decreased level of self-esteem and comfort with your partner.  Having an open discussion with your doctor can be beneficial in identifying causes and solutions to problems with sexuality, and improve this important part of life. Some important topics you should discuss with your doctor are:

  • Effect(s) your diagnosis and/or treatment may have on sexuality

  • Safety of sex during your diagnosis and treatment

  • Birth control and the length of time it should be used

Intercourse is just one form of sexual activity.  Exploring other ways to express sexuality can lead to an active and satisfying sex life.  Keeping open lines of communication with your partner will help to reduce fear and anxiety.

Radiation therapy delivered to the pelvis can sometimes permanently impair fertility.  Fertility may be spared by using modern techniques to plan and deliver radiation.  Seed implants placed into the prostate do not affect fertility.  

If radiation is delivered to a man’s pelvis, he should avoid getting a woman pregnant during and for several weeks after treatment because the risk of harming sperm is uncertain. 

Talk with your physician about the risk of infertility with the treatment before you start treatment.  If there is a possibility of infertility, sperm banking prior to beginning treatment may be considered.  

Sexuality and Fertility (Women; abdomen or pelvis)  

Cancer and cancer treatments can affect sexuality in various ways.  Fatigue and an imbalance in hormone levels can lead to decreased libido (sex-drive).  Changes in appearance may lead to a decreased level of self-esteem and comfort with your partner.  Having an open discussion with your doctor can be beneficial in identifying causes and solutions to problems with sexuality, and improve this important part of life. Some important topics you should discuss with your doctor are:

  • Effect(s) your diagnosis and/or treatment may have on sexuality

  • Safety of sex in your diagnosis and treatment

  • Recommended birth control and the length of time it should be used

Radiation from a machine outside the body does not make you “radioactive”. This means you won’t expose your partner to radiation during sex.  Some women receive radiation therapy in the form of a brachytherapy implant.  Implants may be placed into the uterus or vagina and remain in place for a period of time.  With brachytherapy implants, your partner can be exposed to radiation and sex should be avoided until after the implant is removed.  

Radiation to the pelvis can cause changes in the sex organs.  If the vagina is in the radiation field of treatment, it may become irritated and tender.  As healing occurs, scar tissue may form in the vagina.  The vagina may be thinner, narrower, and not stretch as much as before.  This can lead to pain during intercourse or bleeding afterwards.   Often, this can be prevented by having intercourse several times per week or using vaginal dilators.  

Intercourse is just one form of sexual activity.  Exploring other ways to express sexuality can lead to an active and satisfying sex life.  Keeping open lines of communication with your partner will help to reduce fear and anxiety.

Radiation to the abdomen or pelvis could potentially cause permanent damage to the ovaries.  Many women who have radiation to the abdomen or pelvis cannot get pregnant.  It is important to talk to your physician before beginning treatment if you might want to have children later.

Urination Changes (Pelvis)

Radiation to the pelvis may cause urinary problems, including:

  • increased frequency or urgency of urination

  • burning or pain with urination

  • difficulty starting the flow of urine

  • incomplete emptying of your bladder

  • inability to stop or control the flow of urine

  • awaking in the night to urinate

  • blood in the urine

These side effects usually resolve within a few weeks after treatment.  You may be able reduce or eliminate the side effects by drinking eight 8-ounce glasses of water daily and avoiding caffeinated beverages, alcohol, and tobacco.  You should always talk to your doctor about urinary symptoms to determine if additional testing should be done.  A urine sample may be requested if infection is suspected.