Monday, March 26, 2018

Side effects of radiotherapy

Radiotherapy causes side effects because it affects healthy tissue as well as cancer cells. Healthy tissue is better able to recover than cancer cells, but may be damaged by the radiation in the short or long term. Although most side effects are temporary, some may be permanent and some can appear months or even years after treatment finishes.
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Immediate side effects

Immediate side effects may also be called early or acute side effects. They occur during treatment and up to six months after treatment has finished.

Skin reactions

Everyone who has external beam radiotherapy is at risk of skin damage during or after treatment.
The extent of the skin reaction will depend on a number of factors, including:
  • the dose of radiotherapy given
  • the duration of treatment
  • where on the body it’s given – for example the skin folds of the breast, or the armpit
  • your skin type
  • any existing skin conditions you may have (such as eczema)
  • your age
  • if you’re overweight
  • if you smoke
  • if you’re having chemotherapy at the same time.
Skin reactions usually start around 10 to 14 days after starting treatment, but can happen later in treatment or after it has finished. Most people will have some redness around the area being treated. You may also notice the following changes.
  • The skin may become pinker or darker over time.
  • The skin may feel tender, dry, itchy and sore.
  • The skin may peel or flake as treatment goes on.
  • Sometimes the skin can become red or sore, and may blister or become moist and weepy.
Your treatment team will monitor any side effects and advise you how to take care of your skin according to the type of reaction you have.


It’s important to look after your skin during treatment. This will help prevent infection, reduce pain and help keep the area being treated comfortable.

Usually you’ll be given specific skincare instructions by the radiotherapy team. Most radiotherapy centres advise the following.
  • Wash the treated area gently with warm water, using a mild and gentle soap. Pat the skin dry with a soft towel.
  • Have a shower rather than a bath.
  • Use a non-perfumed deodorant.
  • Use a mild and gentle moisturiser to keep the skin soft.
  • If you want to use anything else on the skin in the treatment area, discuss this with your therapeutic radiographer first.
  • Avoid exposing the treated area to extremes of temperature such as hot water bottles, heat pads, saunas or ice packs during treatment.
  • Avoid exposing the treated area to sun while having radiotherapy and afterwards until any skin reaction has settled down. Use a sunscreen with a high sun protection factor (SPF). Apply it even under clothes too as it’s possible to get sunburnt through some clothing.
  • You may want to avoid swimming during treatment and shortly afterwards (until any skin reactions have healed), as a wet swimsuit can rub the skin and cause discomfort. Also the chemicals in a swimming pool can make the skin dry and irritated. Talk to your specialist or therapeutic radiographer if you normally swim regularly and want to continue.
  • Because friction or rubbing can cause or worsen skin reactions, wearing a soft cotton bra or vest may be more comfortable. You’re usually advised not to wear an underwired bra until your skin heals. Alternatively, you may prefer to go without a bra. If you’ve had your breast removed (a mastectomy) and have been wearing a silicone prosthesis, you may find it more comfortable to wear the soft, lightweight prosthesis (softie or cumfie) you used straight after surgery.
If you develop a skin reaction, it should heal within three to four weeks of your last treatment. If it doesn’t heal within this time, or you have a more severe reaction such as skin peeling or blistering, contact your radiotherapy team, breast care nurse or GP for advice.

Swelling (oedema) of the breast

During treatment your breast or chest area may appear swollen and feel uncomfortable.

This usually settles within a few weeks after treatment. If it continues after this time, talk to your oncologist or breast care nurse as you may need to be seen and assessed by a lymphoedema specialist.

Pain in the breast or chest area

Now and then you may have aches, twinges or sharp pains in the breast/chest area.

Although these are usually mild, they can continue for months or even years, but they usually become milder and less frequent over time.

You may also experience stiffness and discomfort around the shoulder and breast/chest area during and after treatment.

Continuing to do arm and shoulder exercises during your radiotherapy and for several months afterwards may help minimise or prevent any stiffness or discomfort.

Hair loss in the armpit or chest area

Radiotherapy to the armpit will make the underarm hair fall out on that side. Men also experience hair loss in the area of the chest that’s being treated. Hair usually starts to fall out two to three weeks after treatment has started and it may take several months to grow back. For some people, hair lost from radiotherapy may not grow back at all.

Sore throat

If you have treatment to the area around your collarbone, you may develop a sore throat or discomfort when swallowing, during or after your treatment. If this happens, talk to your radiographer, specialist or breast care nurse. It may help to take some simple pain relief in liquid form, particularly before eating, until the discomfort improves.

Tiredness and fatigue

Generally, radiotherapy to the breast doesn’t make people feel unwell, but you may feel very tired during or after your treatment.

Travelling to and from hospital can be tiring in itself. However, many people still manage their daily tasks as usual and some continue to go to work throughout their treatment.

Fatigue is extreme tiredness and exhaustion that doesn’t go away with rest or sleep and may affect you physically and emotionally. This is a very common side effect of cancer treatment. It may start or become worse after radiotherapy has finished. If you’ve also had chemotherapy, you may already have fatigue by the time you start radiotherapy.

Everyone’s experience of fatigue is different. It’s important to know what your limits are and not to expect too much of yourself.


Lymphoedema is swelling of the arm, hand or breast/chest area caused by a build-up of lymph fluid in the surface tissues of the body. It can occur as a result of damage to the lymphatic system, for example because of surgery and/or radiotherapy to the lymph nodes under the arm (axilla) and surrounding area.

Lymphoedema is a long-term condition, which means that once it has developed it can be controlled but is unlikely to ever go away completely. If the arm, hand or breast/chest area on the side of the radiotherapy or surgery swells or feels uncomfortable and heavy, contact your breast care nurse or GP.

Change in breast shape, size and colour

If you’ve had radiotherapy after breast-conserving surgery (wide local excision or lumpectomy), the breast tissue on the treated side may feel firmer, or the breast may be smaller and look different to before. This is because the breast is not a regular shape and it’s not possible to get an even dose of radiotherapy over the whole area being treated.

This is normal but if you’re concerned about differences in the size of your breasts, or if the difference is noticeable when you’re dressed, discuss this with your breast surgeon or breast care nurse.

Late side effects

Some side effects can develop months or even years after the end of radiotherapy. However, improvements with the equipment and accuracy in marking the exact areas to be treated have made many of these side effects much less common.

Serious side effects are very rare and experts agree that the benefits of treatment in reducing the chance of breast cancer returning outweigh the risk of possible side effects.

Radiotherapy to the breast and/or under the arm can cause hardening of the tissue. This is known as fibrosis and is caused by a build-up of scar tissue. If the fibrosis becomes severe, the breast can become noticeably smaller as well as firmer. This is rare but may happen several months or years after radiotherapy has finished.

Under the skin, you may also see tiny broken blood vessels, known as telangiectasia. This is permanent and there’s no treatment for it.

Tenderness can occur over the ribs during treatment. In some people, this may continue but usually improves gradually over time.

Sometimes after treatment to the breast/chest area, part of the lung behind the treatment area can become inflamed, causing a dry cough or shortness of breath. This usually heals by itself over time. More rarely, fibrosis of the upper lung can occur, causing similar side effects.

Although particular care is taken to avoid unnecessary radiotherapy to the tissues of the heart, if radiotherapy is given on the left side you may be at risk of heart problems in future.

Other side effects that can occur later include:
  • weakening of the bones in the treated area, which can lead to rib and collarbone fractures
  • damage to the nerves in the arm on the treated side, which may cause tingling, numbness, pain, weakness and possibly some loss of movement.
If you’re concerned about any side effects, speak to your radiographer, oncologist or breast care nurse.


Breast cancer and its treatments can cause changes to your body and the way you look.


For example, after surgery you’ll be left with a scar or scars. You may have lost your hair if you had chemotherapy. Many people also put on weight during or after treatment.

Even though many of the effects of treatment can be temporary, they can still be very upsetting and have an important effect on how you see your body, not least because they can be an outward sign of having cancer.

Changes to your body after surgery

Most women have surgery as part of their treatment. The first time you look at your body after the operation can be difficult. After surgery your breast/chest area is likely to be bruised and swollen, but this will improve over time.

For some women, surgery doesn’t affect how they feel about themselves, but many others find the changes more difficult to accept. Your confidence and self-esteem may be affected and you may feel unfeminine or unattractive.

Some women feel lop-sided or incomplete. You may feel very self-conscious, for example if you’re in a communal changing room, particularly at first.

Tips for getting used to changes

Research has shown that the sooner you confront the physical changes to your body, the easier you may find it to gain confidence in the way you look. However, some people won’t have had the chance or courage to do this early on.

If you have a partner, letting them see the surgical scars and changes to your body sooner may also make being intimate easier in the long term.

The first few times you look at yourself might make you feel unhappy and shocked, and you may want to avoid looking at yourself again. However, the initial intense feelings you may have will lessen over time as you get more used to how you look now.

Here are some tips to help you get used to looking at your body*:
  • First, it may help to look at yourself in a full-length mirror fully clothed and pick out three things you really like about yourself.
  • After that, the above in lingerie or underwear.
  • When you feel ready you can move on to looking at your naked body in a full-length mirror. Describe what you see and what you like or what makes you feel awkward or uncomfortable.
  • Look at and touch your scars or breast reconstruction so that you get used to how this now feels.
  • The more often you look at and feel your body, the less different it will seem.
*Adapted from Intimacy & sexuality for cancer patients and their partners.

Some women will continue to feel uncomfortable about looking at their body. If you’ve tried the techniques above and still find looking at your body difficult or upsetting, you may find it helpful to speak to a counsellor. Your GP or breast care nurse should be able to arrange this for you.

Reconstruction and prostheses

Many women want to try to restore their natural appearance after breast cancer surgery.

Some women feel that breast re construction enhances their quality of life and helps them to feel more confident overall after a mastectomy.

Some studies have shown that immediate breast reconstruction can help a woman adjust to the changes to her body. Most women who have breast reconstruction are satisfied with the result. However, not everyone’s experience is positive and some women feel unsure of their new shape or feel very aware of their new breast(s).

Breast reconstruction can only reconstruct a breast shape. It can’t bring back your breast or the sensations of the breast and nipple.

A breast prosthesis is an artificial breast form that fits in your bra cup with or without a specially formed ‘pocket’ to replace all or part of the breast that has been removed.

For some women, wearing a prosthesis may be a temporary choice before they have reconstruction at a later date. Other women may choose not (or be unable) to have breast reconstruction and they may find wearing a prosthesis an effective and suitable long-term choice.

The choice of whether or not to have a reconstruction or wear a prosthesis is very personal and some women opt to do neither.

Menopausal symptoms

Menopausal symptoms are a common side effect of treatment for breast cancer. This is because treatments can either stop the effectiveness of female hormones or stop their production altogether.

Menopausal symptoms that may affect how you feel about your body, intimacy and sex include:
  • hot flushes
  • night sweats
  • loss of desire
  • changes to how you experience orgasm
  • vaginal dryness and pain.

Weight gain

Weight gain during and after treatment can happen for several reasons. Some drugs can increase appetite, you may be less active when having treatment, or you may eat more if you’re anxious or because your routine has changed.

Putting on weight can affect how you feel about your body and leave you with low self-esteem. However, some simple changes to the way you eat and exercise can help you lose weight and keep it off.

Hair loss and regrowth

Hair loss can be a distressing side effect of chemotherapy. Your hair may be an important part of how you feel about yourself and losing it can affect your confidence and self-esteem.

Hair loss is almost always temporary and hair usually starts to grow back once chemotherapy has finished, sometimes sooner.


Lymphoedema is swelling of the arm, hand or breast area caused by a build-up of lymph fluid in the surface tissues of the body.

Having lymphoedema can affect you both physically and emotionally. It can make you feel differently about your body and mean that you have to adapt to yet another change in your body and appearance.

If you have lymphoedema you may have to wear a lymphoedema sleeve, which can be a visible sign that something is different about you. Wearing a sleeve may make you feel you have to change the way you dress – for example, no longer wearing sleeveless tops or dresses.
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The two types of radiation blasted at the human body with radiation therapy are x-rays and gamma rays. Do Gamma rays and X-ray's cause cancer? Absolutely.
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Radiotherapy side effects:-
early (acute) reactions
bone marrow, oral mucosa, intestinal mucosa. epidermis.

------- 90 days

chronic (late) responses
lung, CNS ( The central nervous system (CNS) controls most functions of the body and mind. It consists of two parts: the brain and the spinal cord. The brain is the center of our thoughts, the interpreter of our external environment, and the origin of control over body movement. ), kidney, dermis.

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