Side effects of radiotherapy and instructions for patients undergoing radiotherapy
Radiotherapy is used for almost all solid tumors, with the aim of either curing the patient completely or palliating them.
About half of cancer patients will receive radiotherapy during their treatment. In radiotherapy, high-energy radiation is used to kill cancer cells by damaging their genetic material (DNA).
Like all treatments, radiotherapy can cause side effects. Many of these can be prevented and reduced with the use of modern techniques and most will go away after treatment is stopped. Radiotherapy is a local treatment and its side effects are limited to the area being irradiated.
Skin Side Effects
Your skin in the area being irradiated after the second week of treatment may appear red, irritated, swollen, or tanned. After a few weeks, it may become dry or peel. It is important to inform your doctor about any changes in your skin so that he or she can suggest ways to reduce further irritation and prevent infection. These problems gradually disappear after the end of treatment.
Instructions for preventing and caring for your skin in the radiotherapy area:
- Do not wear tight synthetic clothing that puts pressure on the treatment area.
Instead, wear loose cotton clothing. - Do not rub, apply heat or cold (such as heating pads or ice packs) to the treatment area.
- Use only lukewarm water and mild soap. Hot water can damage your skin, so use only lukewarm water to wash the area undergoing radiotherapy.
- Protect the area being irradiated from the sun. Your skin may be particularly sensitive to sunlight.
- Talk to your doctor before shaving the treatment area. He or she may suggest using an electric razor.
- Ask your doctor before using anything on the skin in the treatment area. This includes creams, perfumes, deodorants, body oils, lotions. Many skin products can create a coating on the skin, which may cause irritation or even increase the dose of radiation to the skin.
Hematologic toxicity
Radiation therapy can cause changes in your white blood cell count, your hematocrit, and your platelet count. If this happens, your radiation therapy may need to be stopped for a while and you may be given white or red blood cell growth factors or blood products. This side effect is more common when radiation therapy is combined with chemotherapy.
If you have radiation therapy to the brain
Some unwanted side effects occur during and shortly after radiation therapy ends, and some may occur up to 1 to 2 years later.
Radiation to the brain can cause: Headache, hair loss, nausea, vomiting, fatigue, hearing loss, changes in the skin and scalp, problems with memory and speech
Some of these side effects occur because radiation can cause temporary swelling in the brain, and cortisone is usually given to prevent swelling.
Hair loss
Radiation therapy can cause hair thinning or loss only if you have radiation to the brain area.
Your hair will grow back in a few weeks after treatment ends, but it may be thinner or have a different texture than before.
If you lose your hair, your scalp may be sensitive and irritated. Wear a hat to protect yourself when you are in the sun. If you choose to wear a wig, make sure the lining does not irritate your scalp.
Radiation to the brain area can also cause rare side effects that occur many years after treatment ends, such as memory loss and stroke.
Radiation therapy for cervical – personal country tumors
Patients undergoing radiation therapy for cancer of the larynx, nasopharynx or oral cavity may have side effects such as: Pain (or even open sores) in the mouth or throat, dry mouth, difficulty swallowing, changes in taste, nausea, earache, tooth decay, changes in skin texture, jaw stiffness.
How to take care of your mouth during treatment
- Avoid spicy and raw foods, such as raw vegetables, crackers and nuts.
- Do not eat or drink very hot or very cold foods or drinks.
- Don’t smoke or drink alcohol because they can make mouth sores worse.
- Avoid sugary snacks.
- Ask your doctor to recommend a good mouthwash. The alcohol in some mouthwashes can dry out and irritate the tissues in your mouth.
- Rinse your mouth with lukewarm water, salt, and baking soda every one to two hours. (Use 1 teaspoon of salt and 1 teaspoon of baking soda in 1 quart of water.)
- Drink plenty of fluids (water, chamomile).
- Use sugar-free candy or chew gum to keep your mouth moist.
- Ask your doctor about medications that help heal mouth sores and control pain while eating.
How to care for your teeth during treatment
Before starting radiation therapy, visit your dentist. Ask him or her to talk to your Radiation Oncologist before starting treatment. If you have one or more teeth to be extracted, their removal should be done before starting radiation therapy because it may be more difficult and with an increased risk of complications after the start of treatment.
If you wear dentures, they may not fit well because of swollen gums. If your dentures cause sores, you may need to stop wearing them until after your radiation treatment to prevent the sores from becoming infected.
Your dentist may want to see you during radiation treatment to check your teeth, talk to you about taking care of your mouth and teeth, and help you deal with any problems. He or she will likely tell you to:
- Clean your teeth and gums with a very soft toothbrush after meals
- Use fluoride toothpaste
- Rinse your mouth thoroughly with cool water or a baking soda solution after brushing. (Use 1 teaspoon of baking soda in 250 ml of water.)
Breast radiation therapy:
Acute side effects (during radiation therapy up to three months after)
Radiation to the breast can cause: Skin irritation, dryness and color changes, only in the breast, swelling of the breast (lymphedema).
To avoid skin irritation in the breast area, try not to wear a bra. If this is not possible, wear a soft cotton bra without underwire.
Late side effects (months after radiation therapy ends)
Radiation therapy can also cause long-term changes in your breast. Your skin may be slightly darker and your pores may be larger and more noticeable. Your skin may be more or less sensitive and may feel thicker and firmer than it was before treatment. Sometimes your breast size may change – becoming larger due to lymph accumulation or smaller due to scar tissue. These side effects may last long after treatment but should not last longer than a year.
After about a year, you should not have any new changes in the appearance of your irradiated breast. If you notice any changes in breast size, shape, appearance or texture after this time, tell your healthcare providers right away because this may be a recurrence of the disease.
Less common side effects
Although rare, breast radiation can affect the organs of the chest, including the heart and lungs. This is not as common today as it was in the past, because modern radiation therapy techniques allow radiation oncologists to better focus the radiation with millimeter precision on the area of interest. This allows us to minimize exposure to the heart and lungs. At the same time, modern linear accelerators include an integrated computed tomography (IGRT) scanner, providing the ability to monitor the treatment and automatically correct any deviations.
Cardiac complications: Radiation therapy to the left breast can rarely cause hardening of the arteries, coronary artery disease, valvular disease, or arrhythmias.
Newer advanced techniques such as the ABC (Active Breathing CoordinatorTM) system help the patient control their breathing during radiation therapy. The procedure allows the administration of radiation therapy during the deep inhalation phase, during which the distance of the heart from the breast and chest wall is greater, while at the same time the radiation dose received by the heart and lungs is minimized. Ask your doctor if the hospital where you work has
